Introduction: The aim of this experimental study is to assess, in a porcine model, the onset and grades of vesicoureteral reflux associated with ureteral stents. Methods: Twenty-four female porcine models were used. A 4.7-Fr ureteral stent was placed in all right ureters and kept in place for 6 weeks. Follow-ups were performed on weeks 1, 3, 6, and 12. Ultrasonography, cystoscopy, and fluoroscopy were used to analyze grade of hydronephrosis, presence and grade of vesicoureteral reflux, bacteriuria, and macroscopic changes of the ureteral orifices. Vesicoureteral reflux was classified using a modification of the International Reflux Study Committee grades. Results: 91.7% animals present vesicoureteral reflux, 89.5% grade IA, 3.5% grade IB, and 7% grade II. There is a significant increase in reflux during follow-ups at 3 and 6 weeks, whereas 6 weeks after removal, 26.3% of the ureters still present vesicoureteral reflux. Hydronephrosis and macroscopic changes of the ureteral orifice increase significantly with stenting, but there is no significant association between them and vesicoureteral reflux; the relationship between bacteriuria and the presence of vesicoureteral reflux is not significant either. Conclusion: Vesicoureteral reflux caused by ureteral stents in an animal model is mostly low grade and mainly affects the distal ureter.

1.
Joshi
HB
,
Stainthorpe
A
,
MacDonagh
RP
,
Keeley
FX
,
Timoney
AG
,
Barry
MJ
.
Indwelling ureteral stents: evaluation of symptoms, quality of life and utility
.
J Urol
.
2003
;
169
(
3
):
1065
9
. .
2.
Joshi
HB
,
Stainthorpe
A
,
Keeley
FX
,
MacDonagh
R
,
Timoney
AG
.
Indwelling ureteral stents: evaluation of quality of life to aid outcome analysis
.
J Endourol
.
2001
;
15
(
2
):
151
4
. .
3.
Lee
JW
,
Park
J
,
Lee
SB
,
Son
H
,
Cho
SY
,
Jeong
H
.
Mini-percutaneous nephrolithotomy vs. retrograde intrarenal surgery for renal stones larger than 10 mm: a prospective randomized controlled trial
.
Urology
.
2015
;
86
(
5
):
873
7
. .
4.
Koprowski
C
,
Kim
C
,
Modi
PK
,
Elsamra
SE
.
Ureteral stent-associated pain: a review
.
J Endourol
.
2016
;
30
(
7
):
744
53
. .
5.
Lamb
AD
,
Vowler
SL
,
Johnston
R
,
Dunn
N
,
Wiseman
OJ
.
Meta-analysis showing the beneficial effect of α-blockers on ureteric stent discomfort
.
BJU Int
.
2011
;
108
(
11
):
1894
902
. .
6.
Fischer
KM
,
Louie
M
,
Mucksavage
P
.
Ureteral stent discomfort and its management
.
Curr Urol Rep
.
2018
;
19
(
8
):
64
. .
7.
Mosli
HA
,
Farsi
HM
,
Al-Zimaity
MF
,
Saleh
TR
,
Al-Zamzami
MM
.
Vesicoureteral reflux in patients with double pigtail stents
.
J Urol
.
1991
;
146
(
4
):
966
9
. .
8.
Ramsay
JW
,
Payne
SR
,
Gosling
PT
,
Whitfield
HN
,
Wickham
JE
,
Levison
DA
.
The effects of double J stenting on unobstructed ureters. An experimental and clinical study
.
Br J Urol
.
1985
;
57
(
6
):
630
4
. .
9.
Yossepowitch
O
,
Lifshitz
DA
,
Dekel
Y
,
Ehrlich
Y
,
Gur
U
,
Margel
D
, et al.
Assessment of vesicoureteral reflux in patients with self-retaining ureteral stents: implications for upper urinary tract instillation
.
J Urol
.
2005
;
173
(
3
):
890
3
. .
10.
Sameh
WM
,
Eid
AA
.
Pressure transmission through ureteric stents: a novel in vivo human study
.
Urology
.
2012
;
79
(
4
):
766
70
. .
11.
Belarmino
JM
,
Kogan
BA
.
Management of neonatal hydronephrosis
.
Early Hum Dev
.
2006
;
82
(
1
):
9
14
. .
12.
Nicolle
LE
.
Catheter associated urinary tract infections
.
Antimicrob Resist Infect Control
.
2014
;
3
:
23
8
. .
13.
Soria
F
,
Morcillo
E
,
Serrano
A
,
Rioja
J
,
Budía
A
,
Moreno
J
, et al.
Preliminary assessment of a new antireflux ureteral stent design in swine model
.
Urology
.
2015
;
86
(
2
):
417
22
. .
14.
Lumiaho
J
,
Heino
A
,
Aaltomaa
S
,
Välimaa
T
,
Talja
M
.
A short biodegradable helical spiral ureteric stent provides better antireflux and drainage properties than a double-J stent
.
Scand J Urol Nephrol
.
2011
;
45
(
2
):
129
33
. .
15.
Hill
WG
.
Control of urinary drainage and voiding
.
Clin J Am Soc Nephrol
.
2015
;
10
(
3
):
480
92
. .
16.
Bozzini
G
,
Verze
P
,
Arcaniolo
D
,
Dal Piaz
O
,
Buffi
NM
,
Guazzoni
G
, et al.
A prospective randomized comparison among SWL, PCNL and RIRS for lower calyceal stones less than 2 cm: a multicenter experience: a better understanding on the treatment options for lower pole stones
.
World J Urol
.
2017
;
35
(
12
):
1967
75
. .
17.
Lebowitz
RL
,
Olbing
H
,
Parkkulainen
KV
,
Smellie
JM
,
Tamminen-Möbius
TE
.
International system of radiographic grading of vesicoureteric reflux. International reflux study in children
.
Pediatr Radiol
.
1985
;
15
(
2
):
105
9
. .
18.
Janssen
C
,
Buttyan
R
,
Seow
CY
,
Jäger
W
,
Solomon
D
,
Fazli
L
, et al.
A role for the hedgehog effector Gli1 in mediating stent-induced ureteral smooth muscle dysfunction and aperistalsis
.
Urology
.
2017
;
104
:
242
e8
. .
19.
Weiss
RM
,
Biancani
P
.
Characteristics of normal and refluxing ureterovesical junctions
.
J Urol
.
1983
;
129
(
4
):
858
61
. .
20.
Pollard
SG
,
Macfarlane
R
.
Symptoms arising from double-J ureteral stents
.
J Urol
.
1988
;
139
(
1
):
37
8
. .
21.
Hübner
WA
,
Plas
EG
,
Trigo-Rocha
F
,
Tanagho
EA
.
Drainage and reflux characteristics of antireflux ureteral double-J stents
.
J Endourol
.
1993
;
7
(
6
):
497
9
. .
22.
Werthemann
P
,
Weikert
S
,
Enzmann
T
,
Schostak
M
,
Lebentrau
S
.
A stent for every stone? Prestenting habits and outcomes from a German multicenter prospective study on the benchmarks of ureteroroscopic stone treatment (BUSTER)
.
Urol Int
.
2020
;
104
(
5–6
):
431
6
. .
23.
Shao
Y
,
Shen
ZJ
,
Zhuo
J
,
Liu
HT
,
Yu
SQ
,
Xia
SJ
.
The influence of ureteral stent on renal pelvic pressure in vivo
.
Urol Res
.
2009
;
37
(
4
):
221
5
. .
24.
Tenke
P
,
Kovacs
B
,
Jäckel
M
,
Nagy
E
.
The role of biofilm infection in urology
.
World J Urol
.
2006
;
24
(
1
):
13
20
. .
25.
Rouprêt
M
,
Babjuk
M
,
Compérat
E
,
Zigeuner
R
,
Sylvester
RJ
,
Burger
M
, et al.
European association of urology guidelines on upper urinary tract urothelial carcinoma: 2017 update
.
Europ Urol
.
2018
;
73
(
1
):
111
22
. .
26.
Korkes
F
,
Baccaglini
W
,
Silveira
MA
.
Is ureteral stent an effective way to deliver drugs such as bacillus Calmette-Guérin to the upper urinary tract? An experimental study
.
Ther Adv Urol
.
2019
;
11
:
1
7
.
27.
Hübner
WA
,
Plas
EG
,
Stoller
ML
.
The double-J ureteral stent: in vivo and in vitro flow studies
.
J Urol
.
1992
;
148
(
2 Pt 1
):
278
80
. .
28.
Pereira-Sampaio
MA
,
Favorito
LA
,
Sampaio
FJ
.
Pig kidney: anatomical relationships between the intrarenal arteries and the kidney collecting system. Applied study for urological research and surgical training
.
J Urol
.
2004
;
172
(
5 Pt 1
):
2077
81
. .
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