Impact of Preoperative Ureteral Stenting on Stone-free Rates of Ureteroscopy for Nephroureterolithiasis: A Matched-paired Analysis of 286 Patients

Published:October 18, 2012DOI:


      To determine the effect of preoperative ureteral stenting on success rates of ureteroscopy (URS) for nephroureterolithiasis.

      Materials and Methods

      We retrospectively evaluated patients who underwent URS for nephroureterolithiasis without preoperative indwelling ureteral stents. These patients were matched according to age, sex, body mass index, and stone side, size, site, and number of stones per patient, with patients who had been prestented before URS. Patient data, stone-free rates (SFRs), and complications were compared.


      The study included 286 patients (143 stented vs 143 nonstented). The mean stone size was 5.69 ± 3 mm. The mean number of stones per patient was 1.35 ± 0.7. The overall SFR after 1 URS procedure was 90.9% and higher in prestented than in nonstented patients (95.1% vs 86.7%, P ≤ .013). For ureteral stones, the SFR was 99% in prestented and 90% in nonstented patients (P ≤ .0048). The SFR did not differ between the groups for ureteral stones <5 mm, but was higher in prestented than in nonstented patients for ureteral calculi ≥5 mm (98.2% vs 83.3%, P ≤ .0105). For urinary calculi ≥5 mm, the overall SFR was higher in prestented than in nonstented patients (93.3 vs 78.3%, P ≤ .0054). Perioperative complications occurred in 27 patients (9.4%; Clavien I, 6.6%; Clavien IIIb, 2.8%) without differences between the groups.


      URS is a safe and efficacious procedure for the treatment of nephroureterolithiasis. Preoperative ureteral stent placement is associated with higher SFRs compared with nonstented patients for urinary calculi ≥5 mm. Nonstented patients with urinary calculi ≥5 mm should be informed about the risk for a second-look URS procedure.
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        • Tiselius H.G.
        • Ackermann D.
        • Alken P.
        • et al.
        Working Party on Lithiasis, European Association of Urology. Guidelines on urolithiasis.
        Eur Urol. 2001; 40: 362-371
        • Preminger G.M.
        • Tiselius H.G.
        • Assimos D.G.
        • et al.
        EAU/AUA Nephrolithiasis Guideline Panel. 2007 Guidelines for the management of ureteral calculi.
        J Urol. 2007; 178: 2418-2434
        • Türk C.
        • Knoll T.
        • Petrik A.
        • et al.
        Guidelines on urolithiasis.
        European Association of Urology, 2011 (Available at:) (Accessed March 14, 2012)
        • Hubert K.C.
        • Palmer J.S.
        Passive dilation by ureteral stenting before ureteroscopy: eliminating the need for active dilation.
        J Urol. 2005; 174: 1079-1080
        • Smaldone M.C.
        • Cannon Jr., G.M.
        • Wu H.Y.
        • et al.
        Is ureteroscopy first line treatment for pediatric stone disease?.
        J Urol. 2007; 178: 2128-2131
        • Nerli R.B.
        • Patil S.M.
        • Guntaka A.K.
        • et al.
        Flexible ureteroscopy for upper ureteral calculi in children.
        J Endourol. 2011; 25: 579-582
        • Breda A.
        • Ogunyemi O.
        • Leppert J.T.
        • et al.
        Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2 cm or greater- is this the new frontier?.
        J Urol. 2008; 179: 981-984
        • Perlmutter A.E.
        • Talug C.
        • Tarry W.F.
        • et al.
        Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis.
        Urology. 2008; 71: 214-217
        • Jones B.J.
        • Ryan P.C.
        • Lyons O.
        • et al.
        Use of the double pigtail stent in stone retrieval following unsuccessful ureteroscopy.
        Br J Urol. 1990; 66: 254-256
        • Rubenstein R.A.
        • Zhao L.C.
        • Loeb S.
        • et al.
        Prestenting improves ureteroscopic stone-free rates.
        J Endourol. 2007; 21: 1277-1280
        • Shields J.M.
        • Bird V.G.
        • Graves R.
        • et al.
        Impact of preoperative ureteral stenting on outcome of ureteroscopic treatment for urinary lithiasis.
        J Urol. 2009; 182: 2768-2774
        • Chu L.
        • Sternberg K.M.
        • Averch T.D.
        Preoperative stenting decreases operative time and reoperative rates of ureteroscopy.
        J Endourol. 2011; 25: 751-754
        • Hollenbeck B.K.
        • Schuster T.G.
        • Faerber G.J.
        • et al.
        Comparison of outcomes of ureteroscopy for ureteral calculi located above and below the pelvic brim.
        Urology. 2001; 58: 351-356
        • Fabrizio M.D.
        • Behari A.
        • Bagley D.H.
        Ureteroscopic management of intrarenal calculi.
        J Urol. 1998; 159: 1139-1143
        • Dindo D.
        • Demartines N.
        • Clavien P.A.
        Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205-213
        • Stav K.
        • Cooper A.
        • Zisman A.
        • et al.
        Retrograde intrarenal lithotripsy outcome after failure of shock wave lithotripsy.
        J Urol. 2003; 170: 2198-2201
        • Ather M.H.
        • Paryani J.
        • Memon A.
        • et al.
        A 10-year experience of managing ureteric calculi: changing trends towards endourological intervention - is there a role for open surgery?.
        BJU Int. 2001; 88: 173-177
        • Joshi H.B.
        • Stainthorpe A.
        • Keeley Jr., F.X.
        • et al.
        Indwelling ureteral stents: evaluation of quality of life to aid outcome analysis.
        J Endourol. 2001; 15: 151-154
        • Joshi H.B.
        • Newns N.
        • Stainthorpe A.
        • et al.
        Ureteral stent symptom questionnaire: development and validation of a multidimensional quality of life measure.
        J Urol. 2003; 169: 1060-1064
        • Joshi H.B.
        • Stainthorpe A.
        • MacDonagh R.P.
        • et al.
        Indwelling ureteral stents: evaluation of symptoms, quality of life and utility.
        J Urol. 2003; 169: 1065-1069
        • Lee C.
        • Kuskowski M.
        • Premoli J.
        • et al.
        Randomized evaluation of ureteral stents using validated symptom questionnaire.
        J Endourol. 2005; 19: 990-993
        • Tang L.
        • Gao X.
        • Xu B.
        • et al.
        Placement of ureteral stent after uncomplicated ureteroscopy: do we really need it?.
        Urology. 2011; 78: 1248-1256
        • Pengfei S.
        • Yutao L.
        • Jie Y.
        • et al.
        The results of ureteral stenting after ureteroscopic lithotripsy for ureteral calculi: a systematic review and meta-analysis.
        J Urol. 2011; 186: 1904-1909

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