J Endourol. 2022 Nov 18. doi: 10.1089/end.2022.0386. Online ahead of print.
PURPOSE: Ureteral stenting following uncomplicated ureteroscopy is common practice. Several studies have proven the safety of omitting routine stent placement following distal ureteral stone treatment. However, there is a paucity of data regarding the utility of stent placement for proximal ureteroscopy. We designed a prospective, randomized controlled trial to evaluate the role of ureteral stent placement following ureteroscopy for proximal ureteral and renal stones.
METHODS: Seventy-two patients with proximal ureteral or renal stones measuring up to 1.5cm were prospectively randomized into stented (37) or unstented (35) groups. The surgeon was blinded to the treatment group until after stone treatment. Patients tracked postoperative pain medications and completed validated pain questionnaires on postoperative days 0, 3, 7 and 28. Stents were removed on postoperative day 7. Postoperative follow up imaging was obtained at four weeks.
RESULTS: No statistical differences between the two groups in terms of demographics or stone characteristics. Operative time was longer in the stented group (p<0.03). Patients in the stented group had more irritative urinary symptoms (p <.0001) and pain (p<.0001), lower quality of life scores (p<0.001) and used more narcotics (p<.0005) during the first week but no differences at 30 days. Emergency room visits and overall complication rates were similar between the two groups. 3 nonstented patients required stent placement. 2 stented patients required early stent removal. Urinary tract infections developed in 3 stented but in no unstented patients. Postoperative imaging did not reveal any hydronephrosis in either group and the total stone free rate (SFR) was 94%.
CONCLUSION: For the majority of uncomplicated ureteroscopic treatment of proximal ureteral and kidney stones, it may be safe to omit ureteral stents in order to potentially decrease urinary symptoms and pain while improving short-term quality of life. Further studies with larger patient cohorts may be warranted to confirm our results.