Analysis of Prestenting on Outcomes of Flexible Ureteroscopy for Upper Urinary Urolithiasis: A Historical Control Study

Abstract

Objectives: The aim of this study is to explore the efficacy and safety of flexible ureteroscopy (fURS) with prestenting (PS) for patients and a newly starting department. Method: The data of patients who underwent fURS for calculi with nonprestenting (NPS) after a clinical practice change was compared with PS patients before. Result: In all, 199 patients met the inclusion criteria. There was no significant difference for both groups in basic demography except that the NPS group included more proximal ureteral stone. Subgroup analysis was then used by a different site. There was no significance in sheath success (4/100 vs. 1/99, p = 0.369). Stone free rate (SFR) and success rate between PS and NPS group showed significant difference in total (96.94 vs. 89.58%, p = 0.048, 96.97 vs. 85.00%, p = 0.005 respectively). Better SFR and success rate were found only for the renal stones in subgroup analysis (97.67 vs. 80.49%, p = 0.014, 97.67 vs. 74.42%, p = 0.003 respectively). Operative time was significantly longer based on stenting status (45.969 ± 19.4732 vs. 30.553 ± 8.9645 min, p = 0.01) and there was no difference in subgroup analysis. More complications were found in the NPS group, but no severe complications were encountered. Conclusion: Intentional PS is a feasible try for an amateur fURS surgeon or a newly started department in order to gain a better outcome and lower complications in the whole time. It improves the outcomes when additional small surgery is not the trouble.

Correlation of Operative Time with Outcomes of Ureteroscopy and Stone Treatment: a Systematic Review of Literature

“…In our review, Lumma et al found that pre-stenting actually increased the length of the operation by 4 min yet made no difference to the complication rate [14]. Chen et al also found the operative time to be shorter in patients who were pre-stented, on average by 15 min, yet no significant difference in complications [11].…”

“…Many studies have looked into the role of pre-stenting before URS [11,14]. Stents are most commonly placed if the patient has a compromised renal function, intractable pain, or obstructed infected kidneys; however, some institutions have routinely pre-stented patients prior to URS.…”

“…These include stone size and location, multiplicity, patient comorbidities, and surgeon experience. All these factors have an effect on the operative time which in turn can influence patient outcome [10][11][12][13][14][15][16][17][18][19][20].…”

Prestenting Versus Nonprestenting on the Outcomes of Flexible Ureteroscopy for Large Upper Urinary Stones: A Systematic Review and Meta-Analysis

“…Overall, 7 studies including 3,145 patients (PS 1,408; NPS 1,737) were included in this article (Fig. 1) [8][9][10][11][12][13][14]. Table 1 shows the basic characteristics and quality assessment of the included studies.…”

“…Six studies including 2,888 patients (PS 1,254; NPS 1,634) that met the inclusion criteria reported age and gender [8][9][10][12][13][14]. The PS group was found to be associated with older age (WMD 0.91 year, 95% CI 0.72-1.09; p < 0.001) and more male patients (OR 1.34, 95% CI 1.14-1.56; p < 0.001).…”