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Objective: We aimed to investigate the role of upstream Double J-stent insertion on surgical outcomes of retrograde semi-rigid ureteroscopy in patients with upper ureter stones. Materials and methods: In this retrospective study, we analyzed 290 patients who underwent retrograde semi-rigid ureteroscopy (URS) for upper ureter stones between April 2018 and September 2019. Patients were divided into two groups: delayed primary URS, and upstream, preoperative DJ stent placement URS group (using DJ stent). Operation time, postoperative hospital stay, complications, stone-free rate and risk for repeat operation and requisites for postoperative DJ stent were measured for each patient after ureteroscopy. Results: The median age in the DJ stented and non-stented groups was 49.1±14.3 and 46.4±13 years, respectively (p=0.11). Stone laterality, the proportion of male patients, and urinary tract infection prevalence were comparable between the groups. The median operation time was 15.5±7 min vs. 16±8.7 min (p=0.89), and stone-clearance rate was 95% vs. 88.8 % (p=0.12). Impressively, the need for "rescue" DJ stenting at the end of initial ureteroscopy (27.7% and 54%, respectively, P<0.001), the duration of postoperative indwelling DJ stenting (11.7 vs. 16.4 days, P<0.001, respectively), and the need for redo ureteroscopy (3.75% vs. 11.9%, P<0.03) were all significantly lower in the upstream DJ group. Conclusion: facilitated semi-rigid ureteroscopy with upstream DJ stenting for small and medium size ureteral stones has favorable periprocedural outcomes compared with primary ureteroscopy. Therefore, it seems prudent to preoperatively insert DJ stent whenever ureteroscopy is considered for ureteral stones.

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Objective To investigate the impact of preoperative double J (DJ) stent insertion on outcomes of retrograde semi-rigid ureteroscopy (URS) in patients with upper small and medium sized ureteral stones. Methods Between April 2018 and September 2019, we retrospectively reviewed the medical register of Hillel Yaffe tertiary reference Centre (HYMC) for patients who had undergone retrograde semi-rigid URS for urolithiasis. Patients were separated into two groups depending on whether they accepted the DJ stent placement before URS (Group A) or not (Group B). Operating time, stone clearance rate, number of ‘rescue’ DJ stents, duration of ‘rescue’ stents, complication rate and requirement for repeat URS were compared between groups. Results 318 procedures undertaken in 290 patients were included (Group A, 83 procedures in 80 patiants; Group B, 235 procedures in 210 patients). By comparison with the non-stented group, patients in the preoperative DJ stented group had a higher stone clearance rate, lower complication rate, less need for postoperative ‘rescue’ DJ stent, lower duration of ‘rescue’ stent and lower re-operative URS requirement, including application of a flexible URS. Conclusion Facilitated semi-rigid URS with upstream DJ stenting for small and medium size ureteral stones has favourable periprocedural outcomes compared with primary URS.