Ureteric stenting vs not stenting following uncomplicated ureteroscopic lithotripsy: A prospective randomised trial

Abstract

Objective: To compare three groups of patients who underwent uncomplicated ureteroscopic lithotripsy (URSL) and to evaluate whether stenting could be eliminated after the procedure, as there is no consensus about whether a ureteric stent should be placed after uncomplicated ureteroscopy for stone retrieval. Patients and methods: In this randomised clinical trial (NCT04145063) 105 patients underwent uncomplicated URSL for ureteric stones. They were prospectively randomised into three groups: Group 1 (34 patients) with a double pigtail ureteric stent, Group 2 (35 patients) with a double pigtail ureteric stent with extraction string, and Group 3 (36 patients) with no ureteric stent placed after the procedure. The outcomes measured were: postoperative visual analogue scale (VAS) score for flank pain and dysuria score, urgency, frequency, suprapubic pain, haematuria, analgesia requirement, operative time, re-hospitalisation, and return to normal physical activity. Results: The mean (SD) operative time was significantly longer in groups 1 and 2 compared to Group 3, at 22.2 (9.1), 20.2 (6) and 15.1 (7.1) min, respectively (P < 0.001). The results of the VAS for flank pain and dysuria scores, urgency, frequency, haematuria, and suprapubic pain showed a significant difference at all time-points of follow-up, being significantly higher in groups 1 and 2 compared to Group 3 (all P < 0.001). Further analysis showed that measured outcomes, and analgesia need for groups 1 and 2 were similar, at all time-points except at week 1 and 1 month where Group 2 patients' had less symptoms (P < 0.001). Conclusion: Double pigtail ureteric stent placement appears to be unnecessary in procedures considered 'uncomplicated' by operating urologists during surgery. The advantages of the double pigtail ureteric stent with extraction string over the double pigtail ureteric stent only include earlier and easier removal with earlier relief of symptoms, and less analgesia requirements.

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

“…Patients in the CSG group exhibited a statistically significant worsening of the following IPSS domains: Frequency, Urgency, Nocturia, Storage Symptoms, Total IPSS Score ( p < 0.001), and QoL ( p < 0.002). Our findings are consistent with those of earlier research where nonstented patients had better outcomes in terms of urgency, frequency, suprapubic pain, hematuria, postoperative discomfort, and analgesic use [ 13 , 14 ]. Moreover, a meta-analysis of nine randomized controlled trials of ureteroscopy stenting was presented by Nabi et al, in which individuals who were stented had a higher rate of UTIs [ 15 ].…”

“…Previously conducted studies which eliminated the routine use of stents following an uncomplicated URSL demonstrated severe impairment of sexual function in both genders, particularly in males, with reduced IIEF scores; however, this was temporary [ 14 ]. Among women who were stented, individual domains of the FSFI—the Arousal, Orgasm, and Satisfaction subdomains—were statistically lower in the stented group [ 24 , 25 , 26 ].…”

“…Our study did not include the costs involved with follow-up stent removal, but it merits consideration. Stent insertion after URSL results in extended operative findings, the need for a second procedure to remove the stent, and an increase in the overall costs of surgery [ 14 , 29 ]. Further, a forgotten stent inside the body is associated with negative consequences that can occur in the form of calculus formation, infections, and a requirement of multiple procedures [ 30 ].…”

Outcomes of ureteral stent placement for hydronephrosis in patients with ureteral stone

“…The duration of URS surgery increased when stent insertion was performed; in this case there was a statistically significant difference in the duration as compared with no stent insertion. This result is similar to that of research conducted by Netto et al, (14) but contrary to a study conducted by Jeong et al (15) which stated that there was no significant difference in the duration of URS with and without stents. Another study also stated that if the duration of URS with lithotripsy is more than 45 minutes, it can potentially cause postoperative complications in the stent-free group.…”

Study to Determine the Requirement of Ureteral Stent after Uncomplicated Ureteroscopy for Ureteric Stones

“…Urolithiasis is the communal and oldest diseases of the urinary system. Currently, ureteroscopy is one of the most common procedures among various endourological operations and is performed for a variety of indications, including fragmentation and removal of ureteroscopic stones [12][13] . In 2002, Hoskin et al determined that routine stenting of ureter is unnecessary after uncomplicated ureteroscopic removal of the distal ureteral stone, and the same observation was observed in our study [14][15] .…”