Preoperative stenting for ureteroscopic lithotripsy for a large renal stone

Abstract

Abbreviations & AcronymsAbstract: A large renal stone can be treated ureteroscopically, but the treatment often requires more than one procedure. The use of stenting before ureteroscopy was recently reported. The present study investigated the effectiveness of preoperative stenting before ureteroscopic lithotripsy for large (>15 mm) renal stones. A ureteral stent was intentionally inserted in 25 patients undergoing ureteroscopic surgery. A group of 36 non-prestented patients was used as control. Median stone diameter was 21 mm in both groups. Pre-ureteroscopy stenting significantly improved the stone-free rate, defined as stones <2 mm and <4 mm (P < 0.05), whereas it did not significantly improve the stone-free rate defined as 0 mm (P = 0.12). The uretereoscopy success rate was 72.0% in the stented and 55.6% in the control group (P = 0.09). A 14/16-Fr ureteral access sheath was successfully inserted in 94.7% of the stented patients, and 74.2% of the non-stented patients (P < 0.05). Our findings showed that preoperative stenting is effective for dilation of the ureter, and also to facilitate the insertion of a ureteral access sheath in patients undergoing ureteroscopic lithotripsy for large renal stones.

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

“…In these studies, PS was always passive. The intentional PS studies [8,10] reported a low incidence of severe complications as observed in our study. PS was able to dilate the ureter passively and this dilation provides a relatively easier and safer ureter for UAS and fURS, especially for an amateur fURS surgeon.…”

“…We found less time spent in the operative duration in the NPS group. Similar to Kawahara et al [10], our time during litholithiasis was limited to 1 h to decrease severe complications, such as systemic infections, deep venous thrombosis, and so on, but there was no significant change in the duration of operation between the 2 groups in their study. However, their finding was based on renal stones only.…”

“…Kawahara et al [10] and our study were the only studies that were positive to detect the effects of PS on the outcomes of treatment for upper urinary stones. We would like to hold the view that the reason of higher SFR was that PS straightens and dilates the ureter, allowing easier access and stone retrieval [10]. And the better vision after the drainage of PS helped the dusting and extraction of the stones.…”

“…The impact of PS on the SFR of urinary stones treatment is controversial, especially for fURS only [5,8,10]. Most of the studies report no significant difference in renal stones, but the SFR in ureteral stones was found out to be significantly different.…”

“…Zhang et al [8] reported the procedures performed by 5 different surgeons, but the duration for PS was not reported. Kawahara et al [10] showed a better SFR in renal stones. His findings were in agreement with our results.…”