Is ureteral stenting really necessary after ureteroscopic lithotripsy with balloon dilatation of ureteral orifice? A multi-institutional randomized controlled study

Başeskioğlu, Barbaros; Sofikerim, Mustafa; Demirtaş, Abdullah; Yenilmez, A.; Kaya, Çoşkun; Can, Cavit

doi:10.1007/s00345-011-0697-9

Cited by 29 publications

(13 citation statements)

References 23 publications

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“…In our study, the rate of unplanned re-hospitalization was significantly higher in the unstented group, which was reported in 9 trials [7,16,18,23–25,28,30,33]. The result is questionable due to the varying outcome in the subgroup analysis based on the studies conducted in the last 10 years.…”

Section: Discussioncontrasting

confidence: 54%

Meta-Analysis of Stenting versus Non-Stenting for the Treatment of Ureteral Stones

Wang

Man

et al. 2017

PLoS ONE

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Background and aimUreteroscopic lithotripsy (URL) and extracorporeal shock wave lithotripsy (ESWL) are two widely used methods for the treatment of ureteral stones. The need for ureteral stenting during these procedures is controversial. In this meta-analysis, we evaluated the benefits and disadvantages of ureteral stents for the treatment of ureteral stones.MethodsDatabases including PubMed, Embase and Cochrane library were selected for systematic review of randomized controlled trials (RCTs) comparing outcomes with or without stenting during URL and ESWL. Meta-analysis was performed using RevMan 5.3 and STATA 13.0 software.ResultsWe identified 22 RCTs comparing stenting and non-stenting. The stented group was associated with longer operation time (WMD: 4.93; 95% CI: 2.07 to 7.84; p < 0.001), lower stone-free rate (OR: 0.55; 95% CI: 0.34 to 0.89; p = 0.01). In terms of complications, the incidence of hematuria (OR: 3.68; 95% CI: 1.86 to 7.29; p < 0.001), irritative urinary symptoms (OR: 4.40; 95% CI: 2.19 to 9.10; p < 0.001), urinary infection (OR: 2.23; 95% CI: 1.57 to 3.19; p < 0.001), and dysuria (OR: 3.90; 95% CI: 2.51 to 6.07; p < 0.001) were significantly higher in the stented group. No significant differences in visual analogue score (VAS), stricture formation, fever, or hospital stay were found between stenting and non-stenting groups. The risk of unplanned readmissions (OR: 0.63; 95% CI: 0.41 to 0.97; p = 0.04) was higher in the non-stented group.ConclusionsOur analysis showed that stenting failed to improve the stone-free rate, and instead, it resulted in additional complications. However, ureteral stents are valuable in preventing unplanned re-hospitalization. Additional randomized controlled trials are still required to corroborate our findings.

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Section: Discussioncontrasting

confidence: 54%

Meta-Analysis of Stenting versus Non-Stenting for the Treatment of Ureteral Stones

Wang

Man

et al. 2017

PLoS ONE

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“…Our present data suggests that SO may be protective against unplanned follow-up visits, contrary to the recent meta-analysis performed by Pais et al [8]. This is not surprising given their inclusion of large trials where our algorithm would suggest a stent be placed, such as in the setting of balloon dilatation of the ureteric orifice [14] or use of an access sheath in a patient who is not pre-stented [12]. With judicious indications for SO established, the possibility exists to review the available data with a meta-analysis that incorporates these indications.…”

Section: Discussioncontrasting

confidence: 97%

Indications for stent omission after ureteroscopic lithotripsy defined: A single-institution experience with cost analysis

Bower

Pereira

Al-Alao

et al. 2019

Arab Journal of Urology

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Objectives: To report on our experience with the use of an evidence-based algorithm defining specific indications for stent omission (SO) after ureteroscopic lithotripsy (URSL), as stent placement has been associated with increased cost and morbidity and indications for SO in the setting of uncomplicated ureteroscopy have been proposed but remain vague. Patients and methods: Indications for SO were defined as per the attached figure, data from URSL procedures performed from January 2016 to September 2017 were collected. For procedures eligible for SO, preoperative and intraoperative factors were recorded including: stone burden, presence of preoperative stent, procedure time, access sheath use, and whether SO was performed. Morbidity data were reviewed including: postoperative events, patient telephone calls for bothersome symptoms, unplanned return visits, and admissions within 30 days. Results: In all, 250 URSL procedures were performed during the study period, and 106 (42.4%) were eligible for SO. SO was performed in 60 (24.0%) cases reflecting a 56.7% compliance with the algorithm. There were no readmissions or re-operations within 30 days for the SO group. Lower postoperative event rates were noted in the SO group (16.7% vs 34.8%, P = 0.03), unplanned return visits (8.3% vs 17.4%, P = 0.16) and 30-day readmission rates (0.0% vs 6.5%, P = 0.08) were also lower in the SO group, although they did not reach statistical significance. Analysis also demonstrated a protective effect of SO on unplanned return visits (odds ratio 0.43, 95% confidence interval 0.13-1.42, P = 0.17), although this was not statistically significant. No statistically significant associations were noted between postoperative events and stone burden, procedure time, or presence of preoperative stent. Conclusions: We provide an algorithm defining indications for SO. SO is safe in a significant portion of URSL procedures, and SO appears to decrease postoperative events when performed judiciously.

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“…Developments in the ureteroscope and other peripheral devices have resulted in better surgical outcomes, thereby increasing the number of operations performed. Although there have been reports that ureteral stenting is unnecessary after uncomplicated URSL [ 2 ], we believe that ureteral stenting after URSL is helpful for drainage. However, ureteral stenting has been reported to diminish urination-related quality of life (QoL) in 80% of patients who undergo the procedure [ 3 ].…”

Section: Introductionmentioning

confidence: 81%

Impact of loop-tail ureteral stents on ureteral stent-related symptoms immediately after ureteroscopic lithotripsy: Comparison with pigtail ureteral stents

et al. 2017

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Purpose:To evaluate urination-related quality of life (QoL) in patients with an indwelling ureteral stent immediately after ureteroscopic lithotripsy (URSL) for upper urinary calculi. We compared the effects of loop-tail and pigtail ureteral stents on urinationrelated QoL. Materials and Methods: Of 135 patients who underwent URSL between May 2014 and March 2015 at our hospital, we retrospectively analyzed the records of 70 patients (42 men, 28 women; median age, 63 years) in whom the stent tail was positioned inside the bladder without crossing the midline and who completed the core lower urinary tract symptoms score (CLSS) questionnaire pre-and postoperatively. Results: There were significant differences in incomplete emptying (p=0.048) and bladder pain (p=0.041) between patients with loop-tail versus pigtail ureteral stents after URSL. In the multivariate analysis, stent type had a stronger association with incomplete emptying (p=0.022) and bladder pain (p=0.018) than age, sex, body mass index, stent side, operation time, diameter of ureteral access sheath, and stent type. Conclusions: Patients with loop-tail ureteral stents had better urination-related QoL in the immediate post-URSL stage than patients with pigtail stents. Keywords: Lower urinary tract symptoms; Stents; UreterThis is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Is ureteral stenting really necessary after ureteroscopic lithotripsy with balloon dilatation of ureteral orifice? A multi-institutional randomized controlled study

Abstract: In uncomplicated URS, balloon dilatation of the ureteral orifice should not significantly affect the decision for or against stent placement. Avoiding stents lowers costs and gives fewer irritative symptoms.

Cited by 29 publications

References 23 publications

Meta-Analysis of Stenting versus Non-Stenting for the Treatment of Ureteral Stones

Meta-Analysis of Stenting versus Non-Stenting for the Treatment of Ureteral Stones

Indications for stent omission after ureteroscopic lithotripsy defined: A single-institution experience with cost analysis

Impact of loop-tail ureteral stents on ureteral stent-related symptoms immediately after ureteroscopic lithotripsy: Comparison with pigtail ureteral stents

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