Outcomes and Complications from a Randomized Controlled Study Comparing Conventional Stent Placement Versus No Stent Placement after Ureteroscopy for Distal Ureteric Calculus < 1 cm

Abstract

Ureteric stent insertion following ureteroscopic lithotripsy (URSL) is a common and widely accepted procedure. However, there is no agreement on whether a ureteric stent should be placed following an uncomplicated URSL. Furthermore, the definition of uncomplicated URSL remains debatable. To compare the efficacy, safety, and morbidity of no stent placement with the conventional stent placement after uncomplicated retrograde semirigid URS for a distal ureteric calculus of size ≤1 cm, we compared the corresponding complication rates, emergency visits, secondary interventions, and pain at follow-up. Following an uncomplicated ureteroscopic lithotripsy, 104 patients were randomized into the conventional stented group (CSG) and nonstented group (NSG). Lower urinary tract symptoms and sexual function were evaluated using validated questionnaires (IPSS + IIEF-5 + MSHQ-EjD/FSFI) preoperatively and at 4 weeks during follow-up. Pain scores at follow-up were recorded using a visual analogue scale (VAS). Patients who visited the emergency room or needed secondary interventions before the recommended follow-up time were noted. The Generalized Estimating Equations method was used to explore the difference in change in the domains of IPSS, IIEF-5, MSHQ-EjD, and FSFI between the two groups over time. A significant difference was noted in the following IPSS domains: Frequency, Urgency, Nocturia, Storage Symptoms, Total IPSS Score (p ≤ 0.001), and QoL (p = 0.002); IIEF-5 domains: Overall Score (p = 0.004); MSHQ-EjD domains: Ejaculation Bother/Satisfaction (p ≤ 0.001); and FSFI domains: Lubrication (p ≤ 0.001), Satisfaction (p = 0.006), and Overall Score (p = 0.004). There was no significant difference between the various groups in terms of distribution of emergency visits, readmission and secondary interventions, pain at follow-up (VAS), and need for long-term analgesia. Nonplacement of stents after uncomplicated URS decreases stent-related symptoms and preserves QoL without placing the patient under increased postoperative risk.

Super-mini PCNL (SMP) with suction versus standard PCNL for the management of renal calculi of 1.5 cm–3 cm: a randomized controlled study from a university teaching hospital

“…Prior studies on SMP have reported a high rate of 'tubeless' and 'stent-free' PCNL in the SMP group [17]. The advantages of tubeless and stent-free procedures include decreased patient discomfort, fewer lower urinary tract symptoms and sexual dysfunction, reduced postoperative analgesic needs, shorter hospital stay and avoidance of a second procedure for stent removal [18][19][20].…”

Indwelling ureteral stenting negatively impacts sexual function transiently after endourological procedure among adult male and female patients: a prospective cohort study

“…A systematic review and meta-analysis included only five studies, and only three similar studies have been published after the meta-analysis. (5,8,13,16) Furthermore, in the past, the effects of ureteral stenting on sexual functions were measured using the less specific Ureteral Stent Symptom Questionnaire, which contains only one of the six domains to evaluate sexual dysfunction. (4) Among studies evaluating sexual dysfunction following ureteral stent placement in male patients, only three used a specific IIEF-5 questionnaire with five questions.…”

“…Several preventive and pharmacological treatments for ureteral stenting related lower urinary tract syndromes have been tested. (15,16) Although sexual dysfunction is transient, it still reduces the patient's quality of life. Therefore its treatment should be further investigated.…”