Abstract
INTRODUCTION AND OBJECTIVE: The ureteral stent placement before ureteroscopic lithotripsy (URSL) are reported to facilitate ureteroscopic management of urolithiasis. However, there is no report evaluating the ureteroscopic findings after stent placement. In this study, we first examined the effect of the preoperative ureteral stenting on endoscopic findings and surgical outcome of URSL. METHODS: Among 832 patients who underwent URSL registered in the SMART Study Group from January 2014 to February 2017, 241 cases of single ureteral stones were analyzed. The patients were divided into non-stented patients (n=185) who underwent URSL without preoperative indwelling ureteral stent and stented group (n=56). We evaluated the surgical outcome and endoscopic findings (edema, polyp, stone adhesion, distal ureteric tightness) prospectively based on the SMART classification, which was independently created for this study. RESULTS: Owing to differences in patient characteristics, a 1:1 propensity score matching was performed. In the final matched cohort, 96 cases (48 non-stented vs 48 stented) were available for analysis. The average stone size was 8.3±2.9 and 8.3±2.8 mm in the non-stented and the stented group. The mean operation time was not significantly different between the two groups (44.5±16.7 vs 47.6±26.8 minutes). However, stone free rate in the stented group was significantly higher than the non-stented group (83.3 vs 95.7%, p=0.04) Based on our endoscopic findings, the grade of edema (p=0.18) and polyps (P=0.52) at the stone site were not significantly different between two groups, however, the grade of stone adhesion (p=0.04) and distal ureteral tightness (p<0.01) in the stented group were significantly better than in the non-stented group (Figure 1). CONCLUSIONS: Preoperative ureteral stent placement is associated with better endoscopic findings of stone adhesion and distal ureteric tightness, and may result in a safe and efficacious procedure for URSL. If severe stone impaction is expected, preoperative stent placement is one of the choices to perform an ideal URS operation.Source of Funding: No
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