CUA 2018: Ureteral Stent Versus no Ureteral Stent for Ureteroscopy in the Management of Renal and Ureteral Calculi: A Cochrane Review

Halifax, Nova Scotia ( Urolithiasis is one of the most common urologic diseases with an increasing prevalence in United States and Worldwide. According to recent data, approximately 8% and 10% women and men have urolithiasis in the United States, respectively. With stone being so common, there are treatment modalities that are being developed for effective surgical management. With advancement of surgical endoscopic technology, ureteroscopy (URS) is being used more frequently in the management of amenable stones less than 2cm in size.

Traditionally, ureteral stents are placed following ureteroscopic intervention for the management of renal and ureteral stones. This is done in order to maintain a proper urine drainage from upper urinary tract and prevent renal colic with remaining stone fragments. Generally, stents are placed in roughly 60% of patients after URS for ureteral stones and 80% for kidney stones.

Ureteral stents are common source of post-op morbidity and significantly impacts patients quality of life with irritable stent symptoms including bladder spasm and pain, hematuria and dysuria as well as flank pain when stent is in the kidney.

Current guidelines of the American Urological Association recommends that stents may be omitted when patients meet the following criteria:
1. Those without suspected ureteral injury during the procedure.
2. Those without evidence of ureteral stricture or other anatomical impediments to stone fragment clearance.
3. Those with normal contralateral kidney
4. Those without renal impairment
5. Those in whom secondary URS procedure is not planned

These indications remain debatable and data is necessary to guide the placement or omittment of stent placement after URS. In order to answer this question, authors performed a meta-analysis of the Cochrane database to assess the role of routine placement of ureteral stent following uncomplicated URS for ureteral and kidney calculi. Randomized trials regardless of publication status and language of publication were included in the search. Authors used PRISMA guidelines to select the appropriate articles (Figure 1).

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Authors concluded that ureteral stent placement does not decrease unplanned return visits to the emergency room. Does not decrease post-operative pain or discomfort. Does not decrease secondary procedure rates and urinary tract infection rates. Finally, stent placement does not appreciable prolong the duration of the procedure (operative time)

Presented by: Shreyas Gandhi, MD

Written by: Zhamshid Okhunov, Department of Urology, University of California-Irvine, Twitter: @OkhunovZham, at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia