Editorial Comment on: Percuflex Helical Ureteral Stents Significantly Reduce Patient Analgesic Requirements Compared to Control Stents by Chew et al.

Ureteral stents (USs) in the form of Double-J stents provide solution to the obstruction of the upper urinary tract to a large number of patients. Nevertheless, urinary tract symptoms are observed in significant proportion of patients with USs. ¹ New more advanced stents could solve the mentioned issue. The development of more comfortable stents could be based on improved stent design or stent material/coating or the presence of a drug that could target to the reduction of symptoms. ^2,3

The study by Chew et al. investigated the impact in symptoms of a US with helical design in 15 patients who underwent ureteroscopy for urinary stones. ⁴ The symptomatology of these patients was compared with a historical series of 30 patients who were evaluated according to the same protocol and were managed by the insertion of a Percuflex™ US (Boston Scientific Corporation, Natick, MA). The latter stent is made by the same proprietary material as the helical stent and thus any differences were most likely related to the stent design rather the stent material. The results showed that there was a significant reduction of the amount of analgesics required in the case of the helical US. The pain scores and unscheduled visits were similar among the groups.

These results should be interpreted with care because of the not randomized nature of the study. Moreover, the symptomatology of the patients was accessed with the Visual Pain Analog Scale. A well-validated questionnaire on the stent-related symptomatology such as the urinary stent symptoms questionnaire could provide more information and additional integrity to the presented results. ⁵ Nevertheless, the study provided interesting clues that the rigidity of the common Double-J stent design may be related to the stent-related symptoms. Our practice has relayed for far too long on a design that was mainly focusing on self-retaining properties. The currently presented stent introduces a different concept that the stents should follow the shape of the ureter. This is exactly the success of this investigation; it introduces a concept while providing evidence, though limited, on the efficacy of this design in reducing the stent-related symptomatology. Considering the above mentioned, the urologic community should probably be awaiting the further investigation of the helical US and the introduction of novel stents designed according to the mentioned concept.