Efficacy and safety of the use of infant feeding tubes as internal ureteral stents at Muhimbili National Hospital, Tanzania
Background: Infant feeding tubes are inexpensive, readily available, and have been used as urinary tract stents with some uncertainty about their effectiveness and safety. Double J ureteral stents are available on the market, but among other factors, availability and affordability limit their use in developing countries, including in our hospital. We aimed to compare the efficacy of infant feeding tubes compared to standard double J ureteral stents in patients undergoing open ureteral stenting at Muhimbili National Hospital in Dar es Salaam, Tanzania.
Methods: We conducted a hospital-based cross-sectional analytical study over 12 months. Patients included in the study required open ureteral stenting for different indications and were divided into 2 groups: those for whom infant feeding tubes were inserted during surgery (study group) and those whose surgery used double J stents (control group). After surgery, patients were recruited and observed to ascertain the duration of hospital stay, as well as the presence of haematuria, dysuria, urinary frequency, flank and suprapubic pain, stent migration, and stent encrustation. Observations continued until the day of discharge, after which patients were followed up to the day of stent removal.
Results: A total of 44 patients were enrolled in the study. The mean age of participants was 40 years (range 1 to 75). The majority of participants were female (n = 26; 60%). Among the 44 operations, 19 (43.2%) used the infant feeding tube as a stent whereas the remainder (n = 25; 56.8%) used the standard double J ureteral stent. The mean hospital stay among patients who underwent surgery with the infant feeding tube as a stent was 9.6 days, whereas those who used the standard double J stent stayed for 8.8 days (P = 0.37). Postoperatively, haematuria was observed in 19 (43.2%) of the patients; among these, 15 (79%) of them received infant feeding tube stents and 4 (4.3%) received standard double J stents (Χ2 = 17.4; P = 0.001). The postoperative prevalences of dysuria, flank pain, and suprapubic pain were 6.8%, 20.4%, and 9.1%, respectively. These outcomes did not show association with the type of surgical stent used. None of our study patients experienced postoperative urinary frequency. Imaging studies showed that 57.8% of the infant feeding tube stents were in the normal position postsurgery, whereas all of the standard double J stents were in the normal position (Χ2 = 12.86; P = 0.005). Further, we found that among the 44 patients, only 1 patient (who underwent surgery that used double J stenting) had postoperative stent encrustation (Χ2 = 0.7; P = 0.4).
Conclusions: Despite producing significantly higher incidences of haematuria and malposition, infant feeding tube as ureteral stents were comparable to double J stents in terms of hospital stay post-stenting, dysuria, flank pain, suprapubic pain and encrustation. Future larger prospective studies are needed to confirm these findings.
Keywords: infant feeding tube; double J stent; ureteral stenting complications