Impact of Preoperative Ureteral Stenting in Retrograde Intrarenal Surgery for Urolithiasis

Abstract

Background and Objectives: Ureteral stent insertion passively dilates the ureter. Therefore, it is sometimes used preoperatively before flexible ureterorenoscopy to make the ureter more accessible and facilitate urolithiasis passage, especially when ureteroscopic access has failed or when the ureter is expected to be tight. However, it may cause stent-related discomfort and complications. This study aimed to assess the effect of ureteral stenting prior to retrograde intrarenal surgery (RIRS). Materials and Methods: Data from patients who underwent unilateral RIRS for renal stone with the use of a ureteral access sheath from January 2016 to May 2019 were retrospectively analyzed. Patient characteristics, including age, sex, BMI, presence of hydronephrosis, and treated side, were recorded. Stone characteristics in terms of maximal stone length, modified Seoul National University Renal Stone Complexity score, and stone composition were evaluated. Surgical outcomes, including operative time, complication rate, and stone-free rate, were compared between two groups divided by whether preoperative stenting was performed. Results: Of the 260 patients enrolled in this study, 106 patients had no preoperative stenting (stentless group), and 154 patients had stenting (stenting group). Patient characteristics except for the presence of hydronephrosis and stone composition were not statistically different between the two groups. In surgical outcomes, the stone-free rate was not statistically different between the two groups (p = 0.901); however, the operation time for the stenting group was longer than that of the stentless group (44.8 ± 24.2 vs. 36.1 ± 17.6 min; p = 0.001). There were no differences in the complication rate between the two groups (p = 0.523). Conclusions: Among surgical outcomes for RIRS with a ureteral access sheath, preoperative ureteral stenting does not provide a significant advantage over non-stenting with respect to the stone-free rate and complication rate.

Ureteral Stenting and Urinary Stone Management : A Systematic Review

“…The study focused on unilateral RIRS using the same ureteral access sheath, addressing potential confounders. 7 Contrary to studies favoring preoperative stenting, our results suggest that stone characteristics, not preoperative stenting, influence SFR. Logistic regression modeling revealed no independent predictive power of preoperative stenting for SFR.…”

“…Although calcium oxalate stones were the most common in both groups, uric acid stones were more frequent in the stenting group than in the stentless group (28.6% vs. 15.1%). 7 Concerning surgical outcomes, the operation time was longer for the stenting group than for the stentless group (44.8 24.2 vs. 36.1 17.6, p =0.001). However, there were no statistically significant differences in the stone-free rate (SFR) and postoperative complications between the two groups (p = 0.901 and p = 0.523, respectively).…”

“…However, there were no statistically significant differences in the stone-free rate (SFR) and postoperative complications between the two groups (p = 0.901 and p = 0.523, respectively). 7 In the complication category, two patients in each group experienced postoperative sepsis requiring inotropes, which improved with continued IV antibiotics. Additionally, two patients in the stenting group required postoperative blood Hee Sung et al, 2019.…”

“…A Clavien-Dindo grade 3a patient in the stentless group underwent a postoperative cystoscopic ureteral stent exchange under local anesthesia due to severe pain. 7 Univariate logistic regression models identified a shorter mean stone length (MSL) and lower modified Seoul National University Renal Stone Complexity (mS-ReSC) score as statistically significant factors affecting the SFR (p < 0.001 for both groups). Multivariate analysis corroborated a shorter MSL (p = 0.006) and lower mS-ReSC score (p < 0.001) as independent significant factors for the SFR.…”

“…Multivariate analysis corroborated a shorter MSL (p = 0.006) and lower mS-ReSC score (p < 0.001) as independent significant factors for the SFR. 7 A total 84 patients were randomly assigned to two ureteral stent placement groups (ITT population) between July 2019 and November 2019 in Yoshida et al prospective randomized trial. In the Polaris Ultra group, one patient did not undergo URS due to drug-induced anaphylaxis, and one was excluded from the final analysis because his ureteral stent was accidentally discarded before imaging evaluation.…”