A Prospective Study Comparing Stenting Versus Non-Stenting After Uncomplicated Ureteroscopy for Ureteric Stones

Abstract

The placement of stents has been a standard practice since 1967. The advantage of routine stenting is that it minimizes postoperative ureteral obstruction and renal colic that may result from ureteral oedema caused by balloon dilatation or stone manipulation. There are various disadvantages resulting from it including flank pain, voiding symptoms, infections, stent related stone formation and encrustation. Various studies recommend them to be used only for procedures with complications such as ureteric injury or if a stone fragment remained at the end of the procedure. The aim of our study was to assess the need for routine ureteral stenting after uncomplicated ureteroscopic stone removal. MATERIALS AND METHODSThis study was conducted at Rajarajeshwari Medical College and Hospital, Bangalore, as a prospective randomized controlled trial in Department of Urology between January 2015 and May 2016. In this hospital-based prospective, comparative study, all patients were treated by ureteroscopic lithotripsy. Following the procedure, patients were randomized to the non-stented (n=44) who had no stent placed at the end of the operation and stented (n=52) group having Double DJ stent placement. The assessment criteria included operative time, success rate, postoperative analgesia, complications including (Flank pain, dysuria, haematuria, frequency/urgency), UTI, fever, rehospitalisation and hospital stay. RESULTSThe two groups were comparable with respect to baseline variables of age, gender, mean stone size, side of stone and number of patients turning for radiological follow-up at 3 months. The mean operative time was 38.12±10.76 minutes in the stented group and 32.22±6.72 minutes in the non-stented group. However, this difference was statistically insignificant. There was no significant difference in the two treatment groups with regard to use of intracorporeal lithotripsy. Ureteral dilatation was not required in any patient in both groups. A successful outcome was achieved in 100% of the cases in both groups. Patients with double J stents had statistically significantly more frequency/urgency, dysuria and need of analgesics compared to those without stents. There was no significant difference between the three groups regarding haematuria, fever, flank pain, urinary tract infection, rehospitalisation and mean hospital stay. CONCLUSIONRoutine ureteral stenting does not appear to be warranted in those patients who do not require ureteral dilation during ureteroscopic procedures. Patients without stents had significantly less pain, fewer urinary symptoms and decreased analgesic use postoperatively. Another advantage is cost effectiveness and avoidance of cystoscopy for stent removal.

The Efficacy of JJ Stent on Stone Free Rate After Extracorporeal Shock Wave Lithotripsy: A Retrospective Study

“…Another study of 20 patients with DJ stent and the reported complications stated 90% positive results with one or more than one reported stent related Lower urinary tract symptoms 23 . A study reported pain after SWL stent placement in 44% of patients along with dysuria, urgency and increased use of analgesia, which was subsided after stent removal 24 . A DJ stent, which was forgotten for four years in 40 years old female showed sepsis in ER, the severely encrusted DJ stent was then removed, and patient get symptom free 25 responsible to cause severe morbidity in pediatric population along with UTI, hematuria and encrustation of stent resulting in obstruction 26 .…”