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The aim of this study was to evaluate the necessity for stenting after ureteroscopic lithotripsy. We performed a systematic research of Medline, Embase, Cochrane central registration for RCTs concerning the comparison between stented and non-stented post-ureteroscopic procedures for stone removal and reference lists of the included study were also...
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Context 1
... of hospital stay. Of the 15 trials, 4 studies consid- ered the length of hospital stay and the majority of the par- ticipants were discharged at the same day of surgery [2,17,20,23]. Combined analysis of these four studies showed a longer hospital stay in patients with stents of 1.7 h (P = 0.22, 95% CI [¡1.04 to 4.45]) (Fig. ...
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Objective:
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Introduction
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Citations
... The placement of ureteric stents may also lead to more severe complications such as stent encrustation stent migration or "forgotten DJ stent," which would increase morbidity and expenditures 14 . According to randomized prospective trials, regular stenting following a simple ureteroscopy is not required because stenting may be associated with increased morbidity 15,16 . ...
Background: Ureteroscopic lithotripsy (URL) for ureteric calculi is commonly followed by ureteric stenting in around 60% of patients. However, its use for ureteric stones is debatable due to the stent-related symptoms and extra risks of stent migration, stent encrustation, and vesicoureteral reflux. Aim: To compare stenting to no-stenting in terms of mean operative time and mean hospital stay in patients receiving ureteroscopic lithotripsy for the treatment of ureteric calculi. Methods: This RCT, conducted at the Armed forces institute of urology Rawalpindi, included 104 patients aged 18 to 65 years with newly diagnosed ureteric calculi of 10-20 mm in size. They were subsequently separated into two equal groups, group A patient underwent ureteric stenting, and group B patients without a ureteric stent after uncomplicated calculus clearance with URL. Operative time was recorded in minutes, and hospital stay was measured in hours. Data were analyzed by SPSS version 22. Results: The mean (SD) operative time was significantly longer in group A as compared to Group B, 48.02 ± 4.33 and 33.67 ± 2.27 min, respectively (p-value <0.0001), similarly mean duration of hospital stay for Group B patients was significantly shorter as compared to Group A patients (21.94 ± 2.29 versus 27.10 ± 4.16 hours) which were significant statistically (p < 0.0001). Conclusions: Non-stenting has reduced mean hospital stay duration and reduced mean operative time in comparison with stenting after URL; thus, unless desirably needed stenting in URL should be avoided. Keywords: Ureteroscopy (URL), DJ stenting, operative time. hospital stay. Keywords: Ureteroscopy (URL), DJ/JJ stenting, operative time. Hospital stay.
... The placement of ureteric stents may also lead to more severe complications such as stent encrustation stent migration or "forgotten DJ stent," which would increase morbidity and expenditures 14 . According to randomized prospective trials, regular stenting following a simple ureteroscopy is not required because stenting may be associated with increased morbidity 15,16 . Ucuzal et al 17 reported that patients receiving stents experienced unwanted side effects and significantly compromised their quality of life. ...
Background: Ureteroscopic lithotripsy (URL) for ureteric calculi is commonly followed by ureteric stenting in around 60% of patients. However, its use for ureteric stones is debatable due to the stent-related symptoms and extra risks of stent migration, stent encrustation, and vesicoureteral reflux. Aim: To compare stenting to no-stenting in terms of mean operative time and mean hospital stay in patients receiving ureteroscopic lithotripsy for the treatment of ureteric calculi. Methods: This RCT, conducted at the Armed forces institute of urology Rawalpindi, included 104 patients aged 18 to 65 years with newly diagnosed ureteric calculi of 10-20 mm in size. They were subsequently separated into two equal groups, group A patient underwent ureteric stenting, and group B patients without a ureteric stent after uncomplicated calculus clearance with URL. Operative time was recorded in minutes, and hospital stay was measured in hours. Data were analyzed by SPSS version 22. Results: The mean (SD) operative time was significantly longer in group A as compared to Group B, 48.02 ± 4.33 and 33.67 ± 2.27 min, respectively (p-value <0.0001), similarly mean duration of hospital stay for Group B patients was significantly shorter as compared to Group A patients (21.94 ± 2.29 versus 27.10 ± 4.16 hours) which were significant statistically (p < 0.0001). Practical implication: Every URS procedure does not need stenting. Patients with uncomplicated URS should not under DJ stenting. URS without stenting reduces hospital stay and operative time. Conclusions: Non-stenting has reduced mean hospital stay duration and reduced mean operative time in comparison with stenting after URL; thus, unless desirably needed stenting in URL should be avoided. Keywords: Ureteroscopy (URL), DJ stenting, operative time. hospital stay. Keywords: Ureteroscopy (URL), DJ/JJ stenting, operative time.Hospitalstay.
... Accumulating evidence comparing the routine post-URS DJ-stenting and tubeless procedure did not find significant differences in SFR, the incidence of UTI, ureteral strictures, or unplanned medical visits [5][6][7][8]13,14]. Tang et al., in their Cochrane analysis, also found lower incidences of dysuria, urinary frequency, and hematuria in tubeless simple URS. ...
... We found that the post-operative VAS score was significantly lower in the tubeless subgroup with most patients reporting no pain at all, and in agreement with previous studies, we did not find a difference between the stented and UC subgroups in the postoperative VAS scores [5,7,13,15]. ...
Introduction and objective:
Both double J-stent (DJS) and ureter catheter (UC) drainage represent routine practice following ureterorenoscopy. In select situations, a tubeless approach is possible and safe. In tubeless cases, we use a sheathless dusting technique with the Lumenis® MOSES Pulse™120 H Holmium: YAG laser. We evaluated these three drainage subgroups and compared postoperative pain, complications, and readmissions.
Methods:
A retrospective database of 269 consecutive patients who underwent primary ureterorenoscopy for the treatment of upper urinary tract stones between October 2018 and August 2019. The cohort was divided according to post-operative drainage as Tubeless, UC, and DJS. The decision on whether to perform post-operative drainage was by surgeon preference. Demographic and clinical parameters such as stone location, number, and burden, hydronephrosis grade, and postoperative complications (fever, acute renal failure, and the obstruction of the upper urinary tract by Stone Street) were assessed. Pain was assessed using a 0-10 Visual Analog Scale score (VAS) and the use of analgesics by dose/case in each group.
Results:
There were 70 (26%) tubeless, 136 (50%) UC, and 63 (24%) DJS cases. Patients drained with DJSs had a significantly higher stone burden, more severe obstruction, and prolonged operative time. Tubeless and UC-drained patients had the same stone characteristics with maximal diameters of 8.4 (6.1-12) mm and 8 (5.2-11.5) mm in comparison to the stented group, with 12 (8.6-16.6) mm, p < 0.01. The operation time was the longest in the stented group at 49 min (IQR 33-60) in comparison to the UC and tubeless groups at 32 min (23-45) and 28 min (20-40), respectively (p < 0.001). Auxiliary procedures were more prevalent in the stented group, but the overall stone-free rate was not significantly different, p = 0.285. Postoperative ER visits, readmissions, and complications were the highest in the UC-drained group, at 20% in the UC vs. 6% in the tubeless and 10% in the stented groups. Post-operative pain levels and analgesic use were significantly lower in the tubeless group with a significant reduction in opiate usage.
Conclusions:
A tubeless approach is safe in selected cases with fewer post-operative complications. While DJS should be considered in complex cases, UC may be omitted in straightforward cases since it does not appear to reduce immediate postoperative complications. Those fitted for tubeless procedures had improved postoperative outcomes, facilitating outpatient approach to upper urinary tract stone treatment and patient satisfaction.
... However, there is no reliable method for determining ureteral stent length. Although several reports [24] indicate that ureteral stenting is unnecessary after uncomplicated URSL, many urologists routinely insert a ureteral stent after URSL [25]. In these patients, minimizing stent-related symptoms is important for their quality of life. ...
Purpose
To evaluate the correlation between the position of a ureteral stent and stent-related symptoms in a single-center randomized study.
Methods
A total of 113 patients who required ureteral stent placement after lithotripsy were randomized at a 1:1 ratio into groups with stents crossing and not crossing the bladder midline. The ureteral stent remained in place until postoperative day 14, when we obtained each patient’s International Prostate Symptom Score (IPSS), overactive bladder symptom score (OABSS), and visual analog scale (VAS) pain score.
Results
Comparing changes from baseline IPSS and OABSS scores between the two groups, the midline crossing group had a worse OABSS total score than the not crossing group (3.0 ± 2.8 vs. 2.0 ± 3.3; p = 0.032). There was no significant difference between the crossing and not crossing groups in IPSS total score (6.8 ± 7.6 vs. 5.1 ± 8.5; p = 0.14). The OABSS urgency mean score was significantly lower in the not crossing than in the crossing group (1.1 ± 1.8 vs. 1.6 ± 1.8; p = 0.042). However, there was no significant difference between groups for remaining items of the IPSS and OABSS and the mean VAS total pain score (1.9 ± 2.7 vs. 1.2 ± 1.9; p = 0.14).
Conclusion
A ureteral stent that crossed the bladder midline led to worse urinary symptoms. Choosing the appropriate stent length for each patient is important to minimize stent-related symptoms.
Trial Registration date
1 October 2018; number: UMIN000034067.
... They allow the urine to flow down past a blockage impairing its drainage, which may be either internal or external, and thus help to ensure optimum renal function. They are used frequently in the peri-operative management of urolithiasis, often being placed post ureteroscopic procedures [2], although RCTs have shown that routine stenting perhaps is not needed after an uncomplicated ureteroscopy (URS) [3][4][5][6]. EAU guidelines state that stents need not be used in such cases [7]. This guideline states that stents should be inserted in patients who are at increased risk of complications, such as those with ureteral trauma, residual fragments, bleeding, perforation, UTIs, or in those who are pregnant, and in all doubtful cases, to avoid stressful emergencies. ...
Ureteric stents are conventionally used in daily urological practice. There is ongoing debate on the superiority of different stent materials, particularly in terms of patient tolerance. We conducted a literature review to compare silicone stents and stents made of other materials from a patient tolerability perspective. We conclude that silicone stents are better tolerated but further research is required.
... Stents are often inserted prophylactically, as ureteral manipulation can cause swelling and obstruction. Meta-analyses found no difference in stone-free rates (SFR) [2][3][4]. However, patients who were stented after URS were more likely to complain of irritative micturition symptoms compared to those who did not receive a stent. ...
To compare the outcome of a short-term insertion of a mono-J catheter for 6 h following ureteroscopic stone removal to a conventional double-J catheter. This single-center academic study (Fast Track Stent study 3) evaluated stenting in 108 patients with urinary calculi after ureterorenoscopy. Patients were prospectively randomized into two study arms before primary ureterorenoscopy: (1) mono-J insertion for 6 h after ureterorenoscopy and (2) double-J insertion for 3–5 days after ureterorenoscopy. Study endpoints were stent-related symptoms assessed by an ureteral stent symptom questionnaire (USSQ) and reintervention rates. Stone sizes and location, age, operation duration, BMI, and gender were recorded. Of 67 patients undergoing ureterorenoscopy, 36 patients were analyzed in the double-J arm and 31 patients in the mono-J arm. Mean operation time was 27.5 ± 1.3 min versus 24.0 ± 1.3 min, and stone size was 5.2 mm versus 4.5 mm for mono-J versus double-J, respectively ( p = 0.06 and p = 0.15). FaST 3 was terminated early due to a high reintervention rate of 35.5% for the mono-J group and 16.7% for the double-J group ( p = 0.27). One day after ureterorenoscopy, USSQ scores were similar between the study arms (Urinary Index: p = 0.09; Pain Index: p = 0.67). However, after 3–5 weeks, the Pain Index was significantly lower in those patients who had a double-J inserted after ureterorenoscopy ( p = 0.04). Short-term insertion of mono-J post-ureterorenoscopy results in similar micturition symptoms and pain one day after ureterorenoscopy compared to double-J insertion. The reintervention rate was non-significant between the treatment groups most likely due to the early termination of the study ( p = 0.27). Ethics approval/Trail Registration: No. 18-6435, 2018
... A Cochrane analysis published in 2019 on post-URS stenting revealed that most studies on the topic are limited by retrospective design and small sample size, limiting the ability to determine best practices [1]. Insertion of stents ensures urine drainage and promotes the healing of ureteral lesions after URS; however, they are known to cause stent-related symptoms leading to higher postoperative morbidity and increased costs [2][3][4]. ...
To evaluate factors affecting the outcomes of short-term Mono-J insertion for 6 h following ureteroscopic stone removal. Patients treated with a Mono-J for 6 h after ureterorenoscopy and stone removal were analysed. FaST 1 and 2 (Fast Track Stent Studies), two consecutive single academic centre studies, were conducted between August 2014 and April 2018. In each study, we randomized patients with renal or ureteral calculi to two groups before ureterorenoscopy. FaST 1 compared a Mono-J insertion for 6 h versus Double-J insertion for 3–5 days after ureterorenoscopy. FaST 2 compared a Mono-J insertion to a tubeless procedure in the same clinical setting. All patients were pre-stented for 3–5 days before URS. The study endpoint was stent-related symptoms as assessed by a validated questionnaire (USSQ). Results were stratified by clinical parameters, stone characteristics and operation details. 108 of 156 initially randomized patients undergoing ureterorenoscopy were included. USSQ scores covering the time 3–5 weeks after stone removal showed a significantly reduced urinary symptoms and pain index compared to the scores before ureterorenoscopy. USSQ results before and after stone removal did not correlate with stone size or operation time and did not differ significantly depending on stone localization, the treating endourologist, or ureterorenoscopic device used ( p > 0.05). Six patients (5%) required reintervention. Following secondary ureterorenoscopy and ureteral drainage with a Mono-J for 6 h, quality of life is independent of stone size and localization, operation time, the treating endourologist, and the URS device used.
... Despite their widespread usage, both the American Urological Association (AUA) and European Association of Urologists (EAU) recommend against routine placement of ureteric stents in uncomplicated ureteroscopy procedures [3][4][5]. Ureteric stents can cause troublesome symptoms including lower urinary tract symptoms (LUTS) and pain, which may result in significant morbidity in some patients, burdening urological services through repeat hospital attendances as a result [2,6]. Additionally, stents can cause an increased risk of urinary tract infection (UTI) and can become encrusted, both of which become more problematic with longer indwelling times. ...
... Additionally, stents can cause an increased risk of urinary tract infection (UTI) and can become encrusted, both of which become more problematic with longer indwelling times. [1,2,6] Therefore, when they are placed, it is prudent for them to be removed without unnecessary delays beyond their intended duration [2]. ...
Purpose of Review
To present the latest evidence related to the outcomes and cost of single-use, disposable ureteric stent removal system (Isiris).
Recent Findings
Our review suggests that compared to a reusable flexible cystoscope (re-FC), a disposable flexible cystoscope (d-FC) with built-in grasper (Isiris) significantly reduced procedural time and provided a cost benefit when the latter was used in a ward or outpatient clinic-based setting. The use of d-FC also allowed endoscopy slots to be used for other urgent diagnostic procedures.
Summary
Disposable FCs are effective and safe for ureteric stent removal. They offer greater flexibility and, in most cases, have been demonstrated to be cost-effective compared to re-FCs. They are at their most useful in remote, low-volume centres, in less well-developed countries and in centres where large demand is placed on endoscopy resources.
... We know that patients with ureteral stent may have some morbidities and worse HRQoL scores. In a meta-analysis of 15 randomized controlled trials, the authors stated that patients with ureteral stent had lower urinary tract symptoms, loin voiding pain (RR = 5.24, p = 0.003), hematuria (RR = 7.28, p = 0.001), dysuria (RR = 5.24, p = 0.003), and higher post-operative pain score (p = 0.002) [17]. Because of these morbidities, patients with ureteral stents have worse HRQoL scores than patients without ureteral stent [18]. ...
The effects of treatment modalities such as retrograde intrarenal surgery (RIRS) and shock wave lithotripsy (SWL) on health-related quality of life (HRQoL) were determined in patients with renal stones between 10 and 20 mm. A total of 120 patients were included in the study and prospectively randomized to RIRS or SWL group. A total of 39 patients experienced treatment failure and finally 81 patients (45 patients in the RIRS group, 36 patients in the SWL group) were analyzed for HRQoL. SF-36 survey was used to determine HRQoL pre-operatively, post-operative day 1 and 1 month. The patient and stone characteristics such as age, gender, stone size, grade of hydronephrosis and body mass index were similar between the two groups. At post-operative day 1, the RIRS group was associated with lower scores of role functioning/physical (p = 0.008), role functioning/emotional (p = 0.047) energy/fatigue (p = 0.011), social functioning (p = 0.003) and pain (p = 0.003) when compared to the SWL group. At post-operative 1 month, only pain and emotional well-being scores (p = 0.012 and p = 0.011, respectively) in the RIRS group were statistically lower according to the SWL group. In our study, patients in the SWL group showed more favorable HRQoL scores when compared to the patients in the RIRS group in short-term follow-up.
... In another prospective monocentric study conducted in Italy between 1998 and 2001, the rate of fever > 40°C was 6.8% 24 h after stent insertion and 12.3% 30 days later [8], but no information was provided about the antibiotic therapy. Other studies have reported the rate of irritative bladder symptoms, bacteriuria, and flank pain that can only result from the presence of the JJ [9,10], and accordingly, colonization versus UTI was not discussed [11][12][13][14][15]. Lastly, some studies have considered the outcomes after double pigtail insertion for various indications (e.g., malignancy, urolithiasis, fistula, etc.) and the results are difficult to interpret, notably those regarding infectious complications, because the populations were not homogeneous [16]. ...
Urolithiasis is the main indication for a ureteral JJ stent. Our aim was to determine the incidence of urinary tract infections (UTIs) after a JJ stent for urolithiasis, with an emphasis on antibiotic use. Prospective, multicenter, cohort study over a 4-month period including all of the patients with urolithiasis requiring JJ stent insertion. The clinical and microbiological data and therapeutic information were recorded until removal of the JJ stent. Two hundred twenty-three patients at five French private hospitals were included. A urine culture was performed for 187 patients (84%) prior to insertion of a JJ stent, 36 (19%) of which were positive. One hundred thirty patients (58%) received an antibiotic therapy during surgery: 74 (33%) prophylaxis and 56 (25%) empirical antibiotic therapy, comprising 17 different regimens. The rate of prophylaxis varied according to the center, from 0 to 70%. A total of 208 patients were followed-up until removal of the first stent. The rate of UTIs was 6.3% (13/208); 8.1% of the patients who did not receive a prophylaxis had a UTI versus 1.4% of those who did receive a prophylaxis (p = 0.057). Seven empirical antibiotic regimens were used to treat these 13 patients. Another large panel of antibiotic prescriptions was observed at the time of JJ stent removal. The incidence of a UTI after JJ stent insertion for urolithiasis was 6.3%, in part due to a lack of prophylaxis. An unwarranted diversity of antibiotic use was observed at each step of care.
