What Is the Optimal Stenting Duration After Ureteroscopy and Stone Intervention? Impact of Dwell Time on Postoperative Emergency Department Visits

Abstract

Purpose:AUA stone management guidelines recommend stenting duration following ureteroscopy be minimized to reduce morbidity; stents with extraction strings may be used for this purpose. However, an animal study demonstrated that short dwell time results in suboptimal ureteral dilation, and a pilot clinical study showed this increases postprocedure events. Using real-world practice data we examined stent dwell time after ureteroscopy and its association with postoperative emergency department visits.Materials and Methods:We used the Michigan Urological Surgery Improvement Collaborative registry to identify ureteroscopy and stenting procedures (2016-2019). Pre-stented cases were excluded. Stenting cohorts with and without strings were analyzed. Using multivariable logistic regression we evaluated the risk of an emergency department visit occurring on the day of, or day after, stent removal based on dwell time and string status.Results:We identified 4,437 procedures; 1,690 (38%) had a string. Median dwell time was lower in patients with a string (5 vs 9 days). Ureteroscopy in younger patients, smaller stones, or renal stone location had a higher frequency of string use. The predicted probability of an emergency department visit was significantly greater in procedures with string, compared to without string, when dwell times were less than 5 days (P < .01) but were not statistically significant after.Conclusions:Patients who had ureteroscopy and stenting with a string have short dwell times. Patients are at increased risk of a postoperative emergency department visit around the time of stent removal if dwell time is ≤4 days. We recommended stenting duration of at least 5 days in nonpre-stented patients.

Editorial Comment

“…The authors provide insightful data regarding the relationship between stent dwell time and postoperative emergency department visits in a cohort of over 4,000 patients, concluding that stents should be maintained for at least 5 days postureteroscopy. 1 These findings echo previous work from our institution demonstrating that patients with a 3-day stent dwell time are significantly more likely to have a postprocedure-related event than patients with a 7-day dwell time. 2 While the authors attempt to address multiple confounding surgical variables, the wide number of surgeons and surgical techniques, including stent use vs omission and stent type (which may affect pain 3 ), most certainly introduces some level of unaccounted bias.…”

What Is the Optimal Stenting Duration After Ureteroscopy and Stone Intervention? Impact of Dwell Time on Postoperative Emergency Department Visits. Letter.

“…Therefore, we read the article by Ghani et al with great interest, 4 where the authors divided patients into 2 groups, stenting with a string or without a string. They utilized multivariable logistic regression to assess the risk of an ED visit occurring on the day of or the day after stent removal based on dwell time and string status.…”

“…Second, ureteroscopy in younger patients, smaller stones, or renal stone location had a higher frequency of string use. 4 Therefore, it is recommended to consider ED visits after removal of the stent as the outcome, and to perform both univariate and multivariate analyses on the patient’s age, stone size, stone location, BMI, and other factors in order to obtain an objective understanding based on the patient's individual condition. This approach can guide clinical practice better.…”