Striking a balance: outcomes of short-term Mono-J placement following ureterorenoscopy

Peter Bach,Moritz Reike,Alina Reicherz,Verena Maas,Mirco Brehmer,Joachim Noldus

doi:10.1007/s00240-021-01264-4

Peter Bach, Moritz Reike

Open Access

https://doi.org/10.1007/s00240-021-01264-4

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Abstract

To evaluate factors affecting the outcomes of short-term Mono-J insertion for 6 h following ureteroscopic stone removal. Patients treated with a Mono-J for 6 h after ureterorenoscopy and stone removal were analysed. FaST 1 and 2 (Fast Track Stent Studies), two consecutive single academic centre studies, were conducted between August 2014 and April 2018. In each study, we randomized patients with renal or ureteral calculi to two groups before ureterorenoscopy. FaST 1 compared a Mono-J insertion for 6 h versus Double-J insertion for 3–5 days after ureterorenoscopy. FaST 2 compared a Mono-J insertion to a tubeless procedure in the same clinical setting. All patients were pre-stented for 3–5 days before URS. The study endpoint was stent-related symptoms as assessed by a validated questionnaire (USSQ). Results were stratified by clinical parameters, stone characteristics and operation details. 108 of 156 initially randomized patients undergoing ureterorenoscopy were included. USSQ scores covering the time 3–5 weeks after stone removal showed a significantly reduced urinary symptoms and pain index compared to the scores before ureterorenoscopy. USSQ results before and after stone removal did not correlate with stone size or operation time and did not differ significantly depending on stone localization, the treating endourologist, or ureterorenoscopic device used (p > 0.05). Six patients (5%) required reintervention. Following secondary ureterorenoscopy and ureteral drainage with a Mono-J for 6 h, quality of life is independent of stone size and localization, operation time, the treating endourologist, and the URS device used.

Highlights

The first ureterorenoscopy (URS) was performed about 40 years ago
Despite the downsides of stenting, data from America and Germany indicate that urologists are reluctant to omit stenting [7, 8]
The European guidelines on urolithiasis state that a ureteral catheter insertion for 1 day after URS and stone removal can be performed with similar results [6]

Summary

Introduction

The first ureterorenoscopy (URS) was performed about 40 years ago. In the middle of the 1990s, urologists began questioning the need for post-URS Double-J (DJ) stenting. A Cochrane analysis published in 2019 on post-URS stenting revealed that most studies on the topic are limited by retrospective design and small sample size, limiting the ability to determine best practices [1]. European and American guidelines do not recommend routine DJ insertion after uncomplicated URS [5, 6]; many urologists frequently use stenting. Our research group’s empirical study showed that after primary URS, German urological departments insert a DJ in 79.6% of cases, a Mono-J (MJ) in 7.3% and only 3.6% prefer tubeless

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