Role of ureteral stenting after uncomplicated ureteroscopy for distal ureteral stones: a randomized, controlled trial

• Published in: The Journal of urology Vol. 180; no. 3; p. 961
• Main Authors: Ibrahim, Hamdy M, Al-Kandari, Ahmed M, Shaaban, Hani S, Elshebini, Yahya H, Shokeir, Ahmed A
• Format: Journal Article
• Language: English
• Published: United States 01.09.2008
• Subjects: Adult; Chi-Square Distribution; Female; Follow-Up Studies; Humans; Male; Pain Measurement; Postoperative Complications; Prospective Studies; Recurrence; Stents; Treatment Outcome; Ureteral Calculi - diagnosis; Ureteral Calculi - surgery; Ureteroscopy
• ISSN: 1527-3792
• DOI: 10.1016/j.juro.2008.05.030

We determined the differences in outcome between ureteral stenting and nonstenting following uncomplicated ureteroscopy for distal ureteral stones. A total of 220 patients treated with successful ureteroscopy for distal ureteral stones were randomized to 2 equal groups according to postoperative placement of a ureteral stent (Cook Ireland, National Technological Park, Ireland), including group 1--without a stent and group 2--with a stent. Outcome measures were flank pain and dysuria at 48 hours and 1 week, early postoperative complications, analgesia need, rehospitalization, return to normal physical activity, stone-free rate, stone recurrence and late postoperative complications. Patients were followed a mean +/- SD of 25 +/- 9 months (range 12 to 49). Early postoperative complications, including low grade fever, hematuria and urinary tract infection, were observed in 22 patients (20%) in group 1 and 19 (19%) in group 2, a difference of no significant value. Mean initial hospitalization and time to return to normal physical activity were not different between the 2 groups. At 48 hours and 1 week there was no significant difference in flank pain between the 2 groups, while dysuria was significantly less in the nonstented group. The amount of analgesics required in the recovery room was not different but after discharge from the hospital stented patients used a larger amount of analgesia while the stent was still in the ureter. The stone-free rate at 4 weeks was 100% in each group. Late postoperative sequelae, including stone recurrence and ureteral narrowing, were reported in 6 patients (5.5%) in group 1 and 4 (3.6%) in group 2, a difference of no significant value. Uncomplicated ureteroscopy for treatment of distal ureteral stones is safe without stent placement. Patients without stents have significantly fewer irritative bladder symptoms and are not at risk of increased complications.