Ureteral stenting with subsequent ureteroscopy is a successful and safe method of addressing a narrow ureter that initially does not allow passage of a flexible ureteroscope, as long as persistent subsequent attempts to insert the ureteroscope are made only if it passes easily.
Introduction: Ureteral stents are commonly placed after ureteroscopy (URS). Though studies indicate that stents are associated with patient discomfort, their impact on downstream health services use is unclear. We examined patterns of stent utilization in Michigan and their association with unplanned healthcare encounters.Methods: We used the Michigan Urologic Surgery Improvement Collaborative's Reducing Operative Complications from Kidney Stones (MUSIC ROCKS) clinical registry to identify URS cases between 2016 and 2019. Factors associated with stent placement were examined using bivariate and multivariable statistics. Using multivariable logistic regression, we evaluated whether stent placement was associated with emergency department (ED) visits and hospitalizations within 30 days.
Results:We identified 9662 URS and a stent was placed in 7025 (73%) of these. Frequency of stent use across the 137 urologists varied (11-100%, p<0.001), and was not associated with total case volume. Factors associated with stent use included age and stone size. Pre-stented cases and renal stones had a decreased odds of stent placement. On multivariable analysis after adjusting for risk factors, stent placement was associated with a 1.25 higher odds of ED visit (OR 1.25; 95%CI 1.01-1.54 p=0.043) but not hospitalization (OR 1.28; 95%CI 0.94-1.76 p=0.12). In a single high-volume practice, 0.5% of cases that omit a stent required urgent stenting postoperatively.
Conclusion:There is substantial variation in the use of stents in Michigan, irrespective of case volume. Stent placement significantly increased the odds of an ED visit after surgery. Importantly, stent omission rarely required subsequent urgent stent placement.
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