Practice Patterns of Ureteral Stenting after Routine Ureteroscopic Stone Surgery: A Survey of Practicing Urologists

Abstract

Controversy exists regarding the need for ureteral stent insertion after routine ureteroscopic stone surgery. We designed a questionnaire to assess and better understand the practice patterns of urologists for stent applications. A 26-question survey was distributed to 570 community and academic urologists. The answers were anonymously tabulated to determine the practice patterns for stent placement. Of the 173 respondents, 97.7% performed ureteroscopic surgery, with the majority (77%) performing 1 to 10 procedures per month. Sixty-eight percent of urologists considered more than 70% of their ureteroscopic procedures "routine." Only 21% of urologists dilated the ureteral orifice more than 90% of the time. Those who dilated the ureteral orifice used a balloon (43%), ureteral access sheath (13.5%), or both (21%). The use of an access sheath did not change stenting practices for 75% of urologists. Patterns vary with regard to length of indwelling time, with 85% of urologists maintaining the stent for fewer than 7 days. Most urologists use either cystoscopy (42%) or pull-suture in clinic (37%) to remove stents. Patient tolerance is the most significant problem with stents reported by 97.6% of urologists. The respondents were divided into three experience-based groups: group 1, <2 years of experience; group 2, 2 to 10 years; and group 3, >10 years. Using Fisher's exact test, there were no statistically significant differences between the groups. A wide variability exists among urologists in the practice patterns of stent insertion after routine ureteroscopic surgery. Most consider their procedures routine and are more likely to place stents after ureteral dilation despite growing evidence to the contrary. Knowledge of the varied practices may aid less experienced urologists in their decision to insert a stent after ureteroscopy.