The Comparative Study Of Improved Collar Style Extubation Method And Traditional Clamp-type Extubation Method In The Application Of The Double-J Stent Removed

Objective:With the popularization and development of urologicalendoscopic techniques and ideas,more and more endoscopic equipments andconsumables applied in the clinical,while the Double-J stent is one ofthem.Currently considered the most commonly used Double-J stent cannot beretained in the body for a long time.Therefore the Double-J stent need to bereplaced or removed after a certain time.At present, the common removalmethod of Double-J stent is transurethral cystoscopy extubation surgeryclamping by biopsy forceps.With clinical observation and follow-up，Wefound the extubation by biopsy forceps causes huge damage to the bladderand urethral mucosa.After the operation,hematuria,dysuria and othersymptoms occurs.In order to improve the situation,we develop the improvedcollar style stent-take with clinical extubation experience.Comparing therelated indicators of transurethral cystoscopy extubation using improved collarstyle stent-take or clamping by biopsy forceps,this study aims at finding thebetter extubation method.Methods:We undertook a retrospective study from September2013toJanuary2014with120patients.All the patients were unplugged the underDouble-J stent through the rigid transurethral cystoscope under the sameoperation by the same qualified doctor.Exclusion criteria:⑴Age under18years or over65years, or age from18to65years with disturbance ofsensory,cognitive,communication.⑵With exactly anticoagulantdrugs,Painkiller used history.⑶With other disease can causehematuria,bladder spasms,low urinary tract irritation symptoms,such as benignprostatic hyperplasia(glandular II°and above),Prostate Cancer,urinary tractinfection, Overactive Bladder,Etc.⑷The KUB film or urinary B ultrasound,which took before the operation,shows no Double-J stent in thebody or Double-J stent shifting upper out of bladder,or Double-J stent attachedmany stones which may cause serious injury by forced extubation.⑸Bladdercapacity below60ml.⑹Women in menstrual period.⑺With bone and jointdeformities or myopathy unable to take bladder lithotomy position.We divided the patients who satisfied the study condition into two groupsas the experimental group(improved collar style extubation group) and controlgroup(traditional clamping type extubation)randomly.Then we collected thepatients’ information as age,gender,cause of setting Double-J stent,position ofDouble-J stent before the operation,and extubation time,the degree of painduring extubation(using visual analog scale VAS assessment),first urinationwith or without gross hematuria after extubation,morning urine routineexamination at the three consecutive days after operation and the time firstreturned to normal urination.Then we used SPSS16.0software for statisticalprocessing and analysis.Results:1The differences between the two group of gender,age,anddouble-J-stent position are not statistically significant(P>0.05).So we canexclude the effects of age,sex due to other outcome measures.2The mean extubation time at experimental group is59.57±2.564s, whilethe extubation time at control group is67.13±3.815s.Differences between thetwo groups in the extubation time are not statistically significant(P>0.05).3The differences of pain degree in terms of visual analogue scoringsystem between the experimental group and control group are statisticallysignificant(P<0.05).Mean Rank1=55.25，Mean Rank2=65.75.The pain degreeof experimental group is lower than control group.4Comparing the proportion of that first urination is gross hematuria afterthe operation, the differences between the two groups are statisticallysignificant (P<0.05).And the proportion in experimental group is lower.5The mean time first returned to normal urination in experimental groupis41.88±1.445h,and in control group is47.65±1.513h.The differencesbetween two groups for the time first returned to normal urination are statistically significant (P<0.05), and the time in experimental group is shorter.6Comparing the proportion of getting urinary tract infection afteroperation, the differences between experimental group and the control groupare not statistically significant (P>0.05).Conclusions:By comparing the two methods,we find that the improvedcollar style extubation method can relieve the pain patient suffering during theextubation,reduce the risk of bleeding and the time recovery to normalurination.We need to enlarge the number of patients and optimize thefollow-up visit program to see if the improved collar style extubation methodcan reduce the extubation time or the risk of Urinary tract infections.