Preoperative ureteral stenting prior to ureteroscopy for management of urolithiasis does not impact the postoperative return for unplanned care

Abstract

Introduction: Return for unplanned postoperative care is an important quality metric in the United States. Most of our postoperative return visits occur after ureteroscopy. Routine preoperative ureteral stenting is not recommended by the American Urological Association due to its impact on the quality of life, despite its proposed operative advantages. We evaluated the association between preoperative ureteral stenting and the resulting perioperative outcomes in the context of quality measures such as return to the emergency department (ED) and readmission rates. Materials and Methods: After the Institutional Review Board approval, a retrospective review of patients undergoing ureteroscopy from February 2014 to present was conducted. Patient's demographics and perioperative outcomes were compared based on the presence or absence of a ureteral stent before ureteroscopy. Details and rates of nurse calls, returns to the ED, and readmissions within 90 days were also compared. Results: A total of 421 instances of ureteroscopy, 278 prestented ureteroscopy (psURS), and 143 direct ureteroscopy (dURS) were included for analysis. Preoperative demographics were similar. The psURS cohort was more likely to undergo flexible ureteroscopy, utilized an access sheath more often ( P < 0.0001), and had less ureteral dilation ( P < 0.0001). Prestenting did not influence operative time ( P = 0.8534) or stone-free rates ( P = 0.2241). dURS patients were more likely to call the nurse; however, psURS versus dURS yielded no difference in return to the ED or readmission within 90 days. Conclusions: In this study, preoperative stenting offered few operative advantages and did not meaningfully influence returns to the ED and readmissions within 90 days after ureteroscopy.

The impact of preoperative percutaneous nephrostomy as a treatment strategy before flexible ureteroscopy for impacted upper ureteral stones with hydronephrosis

“…Alternatively, there are some reports on preoperative ureteral stent for ureteral stones (23)(24)(25)(26)(27). Preoperative ureteral stent under fluoroscopy for impacted ureteral s t o n e s c a n p o t e n t i a l l y l e a d t o s t e n t f a i l u r e a n d complications, such as ureteral injury and urinary tract infection.…”

“…However, preoperative ureteral stent before URS has been reported to increase stone-free rate due to ureteral dilation (24,25). In contrast, several studies have reported that preoperative ureteral stent before URS does not impact the stone-free rate and operation time (26,27). Therefore, the impact of preoperative ureteral stent for impacted stone remains controversial.…”