Objective
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.
Results
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.
Conclusion
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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References
- Working Party on Lithiasis, European Association of Urology. Guidelines on urolithiasis.Eur Urol. 2001; 40: 362-371
- EAU/AUA Nephrolithiasis Guideline Panel. 2007 Guidelines for the management of ureteral calculi.J Urol. 2007; 178: 2418-2434
- Guidelines on urolithiasis.European Association of Urology, 2011 (Available at:) (Accessed March 14, 2012)
- Passive dilation by ureteral stenting before ureteroscopy: eliminating the need for active dilation.J Urol. 2005; 174: 1079-1080
- Is ureteroscopy first line treatment for pediatric stone disease?.J Urol. 2007; 178: 2128-2131
- Flexible ureteroscopy for upper ureteral calculi in children.J Endourol. 2011; 25: 579-582
- Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2 cm or greater- is this the new frontier?.J Urol. 2008; 179: 981-984
- Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis.Urology. 2008; 71: 214-217
- Use of the double pigtail stent in stone retrieval following unsuccessful ureteroscopy.Br J Urol. 1990; 66: 254-256
- Prestenting improves ureteroscopic stone-free rates.J Endourol. 2007; 21: 1277-1280
- Impact of preoperative ureteral stenting on outcome of ureteroscopic treatment for urinary lithiasis.J Urol. 2009; 182: 2768-2774
- Preoperative stenting decreases operative time and reoperative rates of ureteroscopy.J Endourol. 2011; 25: 751-754
- Comparison of outcomes of ureteroscopy for ureteral calculi located above and below the pelvic brim.Urology. 2001; 58: 351-356
- Ureteroscopic management of intrarenal calculi.J Urol. 1998; 159: 1139-1143
- 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
- Retrograde intrarenal lithotripsy outcome after failure of shock wave lithotripsy.J Urol. 2003; 170: 2198-2201
- 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
- Indwelling ureteral stents: evaluation of quality of life to aid outcome analysis.J Endourol. 2001; 15: 151-154
- Ureteral stent symptom questionnaire: development and validation of a multidimensional quality of life measure.J Urol. 2003; 169: 1060-1064
- Indwelling ureteral stents: evaluation of symptoms, quality of life and utility.J Urol. 2003; 169: 1065-1069
- Randomized evaluation of ureteral stents using validated symptom questionnaire.J Endourol. 2005; 19: 990-993
- Placement of ureteral stent after uncomplicated ureteroscopy: do we really need it?.Urology. 2011; 78: 1248-1256
- The results of ureteral stenting after ureteroscopic lithotripsy for ureteral calculi: a systematic review and meta-analysis.J Urol. 2011; 186: 1904-1909
Article info
Publication history
Published online: October 18, 2012
Accepted:
June 18,
2012
Received:
March 14,
2012
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial CommentUrologyVol. 80Issue 6
- PreviewThe preceding article uses a retrospective case-control design to determine the presence and magnitude of benefit in the stone-free rate (SFR) of preoperative stenting before ureteroscopy. They found a 15% improvement in the SFR for prestented patients when the stone size was ≥5 mm. This scientifically confirms what most urologists have learned from experience, which is that it is a little easier and more frequently successful to render a stented patient stone free vs a nonstented patient. This seems particularly true as stones get larger.
- Full-Text
- Preview
- Re: Netsch et al.: Impact of Preoperative Ureteral Stenting on Stone-free Rates of Ureteroscopy for Nephroureterolithiasis: A Matched-paired Analysis of 286 Patients (Urology 2012;80:1214-1220)UrologyVol. 81Issue 3
