A randomized prospective study: assessment of transient ureteral stenting by mono-J insertion after primary URS and stone extraction (FaST 3)

Joachim Noldus,Alina Reicherz,Hannah Westhues,Lorine Häuser,Patricia Wenzel,Peter Bach

doi:10.1007/s00240-021-01277-z

Joachim Noldus, Alina Reicherz

Open Access

https://doi.org/10.1007/s00240-021-01277-z

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Abstract

To compare the outcome of a short-term insertion of a mono-J catheter for 6 h following ureteroscopic stone removal to a conventional double-J catheter. This single-center academic study (Fast Track Stent study 3) evaluated stenting in 108 patients with urinary calculi after ureterorenoscopy. Patients were prospectively randomized into two study arms before primary ureterorenoscopy: (1) mono-J insertion for 6 h after ureterorenoscopy and (2) double-J insertion for 3–5 days after ureterorenoscopy. Study endpoints were stent-related symptoms assessed by an ureteral stent symptom questionnaire (USSQ) and reintervention rates. Stone sizes and location, age, operation duration, BMI, and gender were recorded. Of 67 patients undergoing ureterorenoscopy, 36 patients were analyzed in the double-J arm and 31 patients in the mono-J arm. Mean operation time was 27.5 ± 1.3 min versus 24.0 ± 1.3 min, and stone size was 5.2 mm versus 4.5 mm for mono-J versus double-J, respectively (p = 0.06 and p = 0.15). FaST 3 was terminated early due to a high reintervention rate of 35.5% for the mono-J group and 16.7% for the double-J group (p = 0.27). One day after ureterorenoscopy, USSQ scores were similar between the study arms (Urinary Index: p = 0.09; Pain Index: p = 0.67). However, after 3–5 weeks, the Pain Index was significantly lower in those patients who had a double-J inserted after ureterorenoscopy (p = 0.04). Short-term insertion of mono-J post-ureterorenoscopy results in similar micturition symptoms and pain one day after ureterorenoscopy compared to double-J insertion. The reintervention rate was non-significant between the treatment groups most likely due to the early termination of the study (p = 0.27). Ethics approval/Trail Registration: No. 18-6435, 2018

Highlights

The necessity for stenting after ureterorenoscopy (URS) has been widely discussed, and practice differs internationally [1]
Meta-analyses found no difference in stone-free rates (SFR) [2,3,4]
Two patients who were initially randomized into the MJ arm were crossed over into the DJ group by the surgeon

Summary

Introduction

The necessity for stenting after ureterorenoscopy (URS) has been widely discussed, and practice differs internationally [1]. Patients who were stented after URS were more likely to complain of irritative micturition symptoms compared to those who did not receive a stent. European and American guidelines state that urologists can omit stenting after uncomplicated URS and complete stone removal [5, 6]. Patients with a MJ reported fewer irritative micturition symptoms and pain and reported a better performance in everyday life, while the reintervention rate was higher compared to patients who had a DJ inserted [7]. The American guidelines provide a strong recommendation against routine stent placement [5]. The European and German Urological Associations state that routine stenting before URS is not necessary. Data from the German BUSTER study shows that pre-stenting is performed in 70% of patients before stone extraction in Germany [13].

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