Presented by: Rami Ludyansky MD
Hadassah University Hospital

Introduction

Ureteroscopy (URS) has emerged as a valuable minimally invasive technique in urology, especially for the management of stone disease. The optimization of surgical outcomes and the reduction of post-operative complications remain ongoing challenges. Double-J stenting (DJS) after URS is still debated, however its use is considered mandatory by many in order to prevent postoperative pain or infection due to an obstruction in the form of residual fragments or edema. A counterargument to routine post-operative stenting is the affect it can have on the patient’s quality of life in the form of LUTS, hematuria, and social/sexual repercussions. Stent migration, encrustation, pyelonephritis, and retained stent can occur after stent placement. In this study, we aim to evaluate prestenting as factor affecting the success of URS.

Materials

Patients who underwent URS were evaluated retrospectively. Age, stone size, stone localization, Hounsfield Unit (HU), stone-free rate (SFR) and complications (total, fever, acute kidney failure AKF, steinstrasse) were evaluated.

Results

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We analyzed 2068 patients treated with URS between October 2013 and January 2023 – these patients were split into two groups: those who had a stent inserted and those who were tubeless post-operatively.  A comparison of showed that 2.42% of patients experienced complications in the stent group, compared to 1.47% in non-stented group, indicating a 64% high rate of complications in the stented group. Post-operative fever was significantly higher in stented patients, 2.17%, compared to only 0.6% in non-stented patients (a tubeless procedure), representing a 249% difference. Additionally, we found no incidences of steinstrasse in the stent group and 0.78% in the non-stent group, representing a 100% higher risk in the non-stent group. The occurrence of post-acute renal failure (ARF) was explored, with 0.5% of stented patients developing post-ARF compared to 1% in non-stented patients, a 49% difference. Finally, we analyzed stone-free rates and found that 25% of stented patients achieved a stone-free status following URS, compared to 30% in non-stented patients, representing a 15% difference.

Conclusion

An understanding of how routine peri-URS stenting affects post-operative complications, fever, ARF, steinstrasse formation, and stone-free rates can help refine surgical decision-making and guide the development of personalized approaches to enhance patient outcomes. Ultimately, this research has significant implications for improving the effectiveness and safety of future surgical procedures in urology, leading to enhanced patient care and better treatment outcomes.

 

Funding

Hadassah University Hospital 

Lead Authors

Conner C. Brone, MD
Hadassah University Hospital

Co-Authors

Amitay Lorber, MD
Hadassah University Hospital

Mordechai Duvdevani, PHD
Hadassah University Hospital