Presented by: Jonathan Alcantar MD
John H. Stroger, Jr. Hospital of Cook County

Introduction

In contemporary urologic practice, routine stent maintenance is an important preventative measure to minimize ureteral stent encrustation. There is a lack of data exploring risk factors that make patients less likely to follow up for routine ureteral stent management. This is the first prospective study to identify risk factors associated with patients in whom stents were retained beyond the intended maximal stent life. In addition, our study is the first of its kind to explore the impact of retained stents on quality of life measures.

Materials

This is a prospective analysis of patients who underwent first-time ureteral stent placement between 2018 and 2023 by a single-surgeon experience at a single-institution. Patients with stents beyond the intended maximal stent life of 6 months were considered to have retained stents (n=34). The control group consisted of patients who followed up for timely ureteral stent maintenance (n=30). All study participants were consented to complete a 17-item study questionnaire developed by the authors and the validated EQ-5D-5L questionnaire to assess health-related quality of life. 

Results

,

The factors that were previously shown to be significantly different between the two groups still hold true with the updated data with increased statistical significance: the retained stent group is still more likely to have no symptoms (p = 0.0006), less likely to have private insurance (p = 0.03), and more likely to have changed urologist (p = 0.01). The retained stent group was more likely to rate their instructions on stent maintenance as unsatisfactory (p = 0.03). Regarding the EQ-5D-5L questionnaire, the overall health index scores did not significantly differ between the two groups (p = 0.08). The two groups significantly differ in their responses on difficulty with self-care (p = 0.018) and anxiety/depression (p = 0.0414). When the Euroqol data is dichotomized, the retained stent group is more likely to report some degree of difficulty with self-care (slight, moderate, severe, unable) than the control group (p = 0.0046) and more likely to report moderate, severe, or extreme levels of anxiety/depression (p = 0.0108).

Conclusion

This prospective study emphasizes identifiable patient risk factors for developing retained ureteral stents as well as defined the impact on quality of life associated with this problem. The treatment retained stents is fraught with expensive and complicated urologic interventions. In identifying such predisposing factors, we may be able to develop preventative measures to allow for more timely ureteral stent follow up in order to minimize complex urologic sequelae of retained ureteral stents.

Funding

None

Lead Authors

Mark Wille, MD
John H. Stroger, Jr. Hospital of Cook County

Co-Authors

Jonathan Alcantar, MD
John H. Stroger, Jr. Hospital of Cook County

Alicia Roston, MD
John H. Stroger, Jr. Hospital of Cook County