Ureteral Stenting After Routine Ureteroscopy: Is Earlier Stent Removal Feasible?
Stephen C. Hill, BA1, Alexander Boyko, BA1, Samir Merheb, BS1, Michelle Hsu, BS2, Mark Biebel, MD3, Mark H. Katz, MD3, Richard K. Babayan, MD3, Shaun E. Wason, MD3, David S. Wang, MD3
1Boston University School of Medicine, Boston, MA, 2Boston University School of Public Health, Boston, MA, 3Boston Medical Center, Department of Urology, Boston, MA
Ureteroscopy is a standard treatment option for urinary tract calculi. Common protocol is to place an internal ureteral stent after ureteroscopy for up to one week. The minimal length of time required for stenting after ureteroscopy is not well defined. Ureteral stents are associated with significant morbidity, including pain and discomfort. The objective of this study was to determine if there were any difference in postoperative unplanned clinic or ER visits based on duration of stent placement. We sought to determine if earlier stent removal was feasible.
This is a single-institution IRB approved retrospective review of 231 ureteroscopy cases with laser lithotripsy or basket extraction for urinary tract calculi performed during 2018 by multiple surgeons. The main outcome measure was number of unplanned ED or outpatient visits within 30 days following surgery. Log rank test and Cox regression modeling (adjusted for sex, age, and presence of an impacted stone) were used to analyze if there were an association between unplanned visits and length of stent placement (number of days). The patients were separated into three groups based on stent duration: 1 (0-3 days), 2 (4-6 days), and 3 (7+ days).
Of the 223 patients, there were 59 in group 1 (26.5%), 80 in group 2 (35.9%), and 84 in group 3 (37.7%).
218 (97.8%) were event free within the 30-day post-operative period. 5 (2.2%) patients had an unplanned visit after stent removal (2 in groups 1 and 2, 1 in group 3). There was no statistical difference between groups (p value = 0.667), and Cox regression showed no association between duration of stent placement and unplanned visits, when adjusted for sex, age, and the presence of impacted stones (p value = 0.674).
18 (8%) patients (3 (1.3%) in group 1, 8 (3.6%) in group 2, and 7 (3.1%) in group 3) had an unplanned visit during the 30-day post-operative period, including pre- and post-stent removal. Cox regression showed no association between duration of stent placement and unplanned visit, adjusted for sex, age, and presence of impacted stones (p value = 0.610).
We found no difference in unplanned clinic or ER visits in patients based on the duration of stent placement following routine ureteroscopy. Stent removal after 3 days appears to be sufficient to minimize morbidity and complications after uncomplicated ureteroscopy.
Further prospective studies are required to further define optimal duration of stent placement.
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