AUA 2018: Ureteral Stent Placement During Shockwave Lithotripsy: Characterizing Guideline Discordant Practice

San Francisco, CA ( Abhinav Khanna, MD of the Glickman Urological and Kidney Institute Cleveland Clinic presented on stent placement during Extracorporeal Shockwave Lithotripsy (ESWL). To begin, Abhinav addressed the current clinical guidelines which advise against using ureteral stents during ESWL. In addition, Abhinav discussed eight prospective randomized clinical trials and two meta-analyses that show stent placement during ESWL does not improve stone free-rates nor reduce steinstrasse, and may increase lower urinary-tract symptoms. 

The primary objective of the study was to quantify the frequency of stent placement during ESWL, and secondly to analyze the association between stent placement during ESWL with ER visits and re-operation rates. The study used databases from AHRQ Healthcare Cost and Utilization Project which comprised of surgical data from New York, Florida, Iowa, and California.

The study group consisted of 128, 040 patients who underwent ESWL, in which 20,800 (16.2%) had a ureteral stent placed during their procedure. The clinical factors associated with ureteral stent placement were old age and greater comorbidity burden, in which Abhinav hypothesize was a result of surgeons wanting to optimize outcomes for patients they viewed were more susceptible to postoperative complications. Higher income, private insurance, lack of insurance, and metropolitan residency were considered non-clinical factors. Patients who underwent ureteral stent placement during ESWL also had a higher rate of ER visits in the first month after ESWL, as well as a higher rate of reoperation within 3 months.

Abhinav concluded 16% of the patients in the study group were still stented during ESWL, even though clinical guidelines advise otherwise. Stent placement during ESWL was also shown to not improve rates of ER visits or reoperation. Limitations of the study included lack of data on stone characteristics as well as lack of knowledge of laterality of re-operation. In his final statements, Abhinav suggests for future studies to survey surgeons on the reason for stent placement during ESWL while also calling for clinical practices being more in line with clinical guidelines.

Presented by: Abhinav Khanna, MD, Glickman Urologic and Kidney Institute, Cleveland Clinic
Co-Authors: Manoj Monga, Tiangming Goa, Nitin Yerram, Andrew Sun, Jesse Schold, Robert Abouassaly
Author Affiliation: Glickman Urological and Kidney Institute Cleveland Clinic

Written by: Luke Limfueco, Medical Writer for at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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