A Global Perspective of Stenting after Ureteroscopy: an Observational Multicenter Cohort Study

Abstract

Objectives: With an increasing number of patients undergoing ureteroscopic surgery worldwide for stone disease, and the concomitant pressures on health care resources, we aimed to review global patterns for ureteric stenting following ureteroscopy. With a centralized electronic database, a longitudinal cohort study was designed to help define the indications for stenting, type of drainage, and methods of stent removal. Methods: This multicenter study was conducted prospectively, with centralized data acquisition by uCARE (research arm of the Société Internationale d'Urologie), and registered at ClinicalTrials.gov (NCT03567421). Along with baseline demographic data, details were entered for stone imaging characteristics, intraoperative information, including urine culture, and exit strategy for stent removal. An independent audit was undertaken to sample the accuracy of data entered across the sites. Results: In total, 2544 patients were included from 50 centers in 15 countries. There were 1969 patients with ureteric stones, and 942 with renal stones. While 41% ureteric stones were distal (median length 10mm), 52% renal stones were in the lower pole (median diameter 11 mm). The majority of patients (68.8%) were given antibiotics at induction; 20.6% were “pre-stented” before the ureteroscopy, and a high percentage were stented following ureteroscopy (91%). The majority of the stents (85.1%) were polyurethane, mean duration of stent after surgery was 27 days, and 80% of stent removals were undertaken in the operating room. Conclusion: This is one of the largest prospective global cohort studies, reflecting widespread usage of stenting, despite emerging evidence to the contrary. Stent removals may also be modified with time, as the pressure on health care resources mounts.