Abstract
BackgroundStent placement before retrograde intrarenal surgery (RIRS) can theoretically expand the ureter to improve access and remove stones. The purpose of this study was to investigate the effect of preoperative ureteral stenting on access and surgery.MethodsWe retrospectively analyzed patients who underwent RIRS between January 2010 and December 2016 at multiple centers. The patients were divided into two groups based on whether or not a ureteral stent was inserted preoperatively. The characteristics of the stone (size, number, density, and location), the success rate of the access sheath placement, perioperative complications, operative times, hospitalization periods, the period for which the stents remained, postoperative urinary tract infection rates, stone-free rates, and additional treatment rates were analyzed.ResultsOverall, 727 patients were included in the study (113 were pre-stented and 614 were non-stented). The median stone size was 12.2 mm. The overall stone-free rate (SFR) was 85.8% for the pre-stented group and 83.2% for the non-stented group, showing no significant (p = 0.498) difference between the two groups. Preoperative ureteral stenting improved the success rate of sheath placement (93.8% vs. 85.3%, p = 0.023) during surgery. The access sheath size in participants in the pre-stented group showed a tendency to be larger than that in participants in the non-stented group. However, there were no differences in perioperative complications, operative times, additional treatment rates, and stone-free rates.ConclusionsAlthough preoperative ureteral stenting did not affect operative outcomes, it increased the success rate of access sheath placement. Depending on the patient’s characteristics, preoperative ureteral stenting can be considered as an adjunctive option when access sheath insertion is considered during RIRS.
Highlights
Stent placement before retrograde intrarenal surgery (RIRS) can theoretically expand the ureter to improve access and remove stones
Clinical characteristics of the patients according to preoperative ureteral stenting A total of 727 patients were included in the study, including 614 in the non-stented group and 113 patients in the preoperatively stented group
Complexities of the renal stones were significantly higher in patients in the preoperatively stented group than in the non-stented group and the related hydronephrosis was different between the two groups. (Table 1)
Summary
Stent placement before retrograde intrarenal surgery (RIRS) can theoretically expand the ureter to improve access and remove stones. Retrograde intrarenal surgery (RIRS) is currently one of the standard treatments for patients with kidney stones < 2 cm [1]. Advances in technologies such as the development of new flexible ureteroscopes (URS) and small diameter effective lasers have made RIRS an efficient and safe option to manage urinary stones [2]. Several studies have reported that preoperative ureteral stenting affected the outcome of ureteroscopic stone surgery [4,5,6,7]. We sought to investigate the relationship between preoperative ureteral stent placement and renal stone surgery outcomes
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