MP63-05 THE ROLE OF URETERAL STENTING FOLLOWING UNCOMPLICATED URETEROSCOPY FOR URETERAL AND RENAL STONES: A RANDOMIZED, CONTROLLED TRIAL

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy VI (MP63)1 Apr 2020MP63-05 THE ROLE OF URETERAL STENTING FOLLOWING UNCOMPLICATED URETEROSCOPY FOR URETERAL AND RENAL STONES: A RANDOMIZED, CONTROLLED TRIAL Amy Reed* and Christopher Allam Amy Reed*Amy Reed* More articles by this author and Christopher AllamChristopher Allam More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000938.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It is well established that uncomplicated distal ureteroscopy can be safely performed without leaving a ureteral stent. However, there is a paucity of data regarding the utility of stent placement for proximal ureteral or renal stones following ureteroscopy. We designed a prospective, randomized controlled trial to evaluate the role of ureteral stent placement following ureteroscopy and pyeloscopy in proximal ureteral and renal stones. Primary objective was short term complications and secondary objectives evaluated analgesic use and postoperative pain. METHODS: Seventy-one patients with proximal ureteral or renal stones 1.5cm or under were prospectively randomized into stented (35) or unstented (36) groups. Stones were managed with a combination of semi-rigid ureteroscopy or flexible ureteroscopy. Patients tracked postoperative analgesic use and completed validated pain questionnaires on postoperative days 1, 3, 7 and 30. Patients with stents had removal on postoperative day 7. Postoperative follow up imaging was obtained at four weeks. RESULTS: Overall complication rate between the stent and unstented group were not significantly different (p .9). In the stented group, there was an overall complication rate of 37% including 3 readmissions for pain (8.5%), 7 visits to the ED for pain (20%), 4 UTIs (11.4%) and 1 urinary retention (2.8%). In the unstented groups, overall complication rate was 23% including 3 readmissions for stent placement (8%) and 5 ED visits for pain (15%). Mean stone size was 7.8mm. Operative time was longer in the stented group (p<.03). Younger patient age was associated with postoperative complications (p <.002). Patients in the stented group had significantly more irritative urinary symptoms (p <.0001) and pain (p<.0001), more days off work (p<.01) and more narcotic use (p<.0005). Postoperative imaging was available in 53 patients (76.8%) with no obvious strictures and stone free rate (SFR) of 94%. CONCLUSIONS: Patients without stents after ureteroscopy have less pain and urinary symptoms, miss fewer days of work and have decreased narcotic use postoperatively. For the majority of patients, it may be possible to safely omit ureteral stents following uncomplicated ureteroscopy for proximal ureteral and renal stones, although further studies with larger patient cohorts are warranted. Source of Funding: The views expressed are those of the [author(s)] [presenter(s)] and do not reflect the official views or policy of the Department of Defense or its Components. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e955-e956 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amy Reed* More articles by this author Christopher Allam More articles by this author Expand All Advertisement PDF downloadLoading ...