Abstract
We conducted a prospective, randomized study to evaluate whether postoperative ureteral stenting is necessary after ureteroscopic holmium laser lithotripsy. A total of 115 consecutive patients with distal or middle ureteral calculi amenable to ureteroscopic holmium laser lithotripsy were prospectively randomized into stented group (n = 58) and nonstented group (n = 57). The stent was routinely placed in the treated ureter for 2 weeks. The outcomes were measured with postoperative patient symptoms, stone-free rates, early and late postoperative complications, and cost-effectiveness. The postoperative symptoms were measured with Ureteral Stent Symptom Questionnaire (USSQ). All patients completed a 12-week follow-up. There was no significant difference between two groups with respect to the patient age, stone size, stone location and mean operative time. According to the USSQ, the symptoms of the stented group were significantly worse compared to the nonstented group (P = 0.0001). In the stented group, two patients had high fever for 1 week after the operation, stent migration was found in two patients, and the stents had to be removed earlier in five patients because of severe pain or hematuria. The cost of the stented group was significantly higher than the nonstented group. The stone-free rate was 100% in both groups. No hydronephrosis or ureteral stricture was detected by intravenous pyelogram in the 12th week postoperative follow-up. In conclsion, we believe that routine stenting after ureteroscopic intracorporeal lithotripsy with the holmium laser is not necessary as long as the procedure is uncomplicated for distal or middle ureteral calculis less than 2 cm.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Harmon WJ, Sershon PD, Blute ML et al (1997) Ureteroscopy: current practice and long-term complications. J Urol 157:28–32. doi:10.1016/S0022-5347(01)65272-8
Netto NR, Claro JA, Esteves SC et al (1997) Ureteroscopic stone removal of distal ureter: why change? J Urol 157:2081–2083. doi:10.1097/00005392-199706000-00012
Duvdevani M, Chew BH, Denstedt JD (2006) Minimizing symptoms in patients with ureteric stents. Curr Opin Urol 16:77–82. doi:10.1097/01.mou.0000193375.29942.0f
Richter S, Ringel A, Shalev M et al (2000) The indwelling ureteric stent: a ‘friendly’ procedure with unfriendly high morbidity. BJU Int 85:408–411. doi:10.1046/j.1464-410x.2000.00478.x
Ringel A, Richter S, Shalev M et al (2000) Late complications of ureteral stents. Eur Urol 38:41–44. doi:10.1159/000020250
Hosking DH, McColm SE, Smith WE et al (1999) Is stenting following ureteroscopy for removal of distal ureteral calculi necessary? J Urol 161:48–50. doi:10.1016/S0022-5347(01)62058-5
Denstedt JD, Wollin TA, Sofer M et al (2001) A prospective randomized controlled trial comparing nonstented versus stented ureteroscopic lithotripsy. J Urol 165:1419–1422. doi:10.1016/S0022-5347(05)66320-3
Cheung MC, Lee F, Leung YL et al (2003) A prospective randomized controlled trial on ureteral stenting after ureteroscopic holmium laser lithotripsy. J Urol 169:1257–1260. doi:10.1097/01.ju.0000053763.30693.ef
Borboroglu PG, Amling CL, Schenkman NS et al (2001) Ureteral stenting after ureteroscopy for distal ureteral calculi: a multi-institutional prospective randomized controlled study assessing pain, outcomes and complications. J Urol 166:1651–1657. doi:10.1016/S0022-5347(05)65646-7
Damiano R, Autorino R, Esposito C et al (2004) Stent positioning after ureteroscopy for urinary calculi: the question is still open. Eur Urol 46:381–387. doi:10.1016/j.eururo.2004.04.004 discussion 387–8
Djaladat H, Tajik P, Payandemehr P et al (2007) Ureteral catheterization in uncomplicated ureterolithotripsy: a randomized, controlled trial. Eur Urol 52:836–841. doi:10.1016/j.eururo.2007.01.042
Joshi HB, Stainthorpe A, MacDonagh RP et al (2003) Indwelling ureteral stents: evaluation of symptoms, quality of life and utility. J Urol 169:1065–1069. doi:10.1097/01.ju.0000048980.33855.90
Wills TE, Burns JR (1994) Ureteroscopy: an outpatient procedure? J Urol 151:1185
Tawfiek ER, Bagley DH (1999) Management of upper urinary tract calculi with ureteroscopic techniques. Urology 53:25. doi:10.1016/S0090-4295(98)00462-2
Boline GB, Belis JA (1994) Outpatient fragmentation of ureteral calculi with mini-ureteroscopes and laser lithotripsy. J Endourol 8:341
Ryan PC, Lennon GM, McLean PA et al (1994) The effects of acute and chronic JJ stent placement on upper tract motility and calculus transit. Br J Urol 71:434–439
Lennon GM, Thornhill JA, Grainger R et al (1997) Double pigtail ureteric stent versus percutaneous nephrostomy: effects on stone transit and ureteric motility. Eur Urol 31:24–29
Teichman JMH, Vassar GJ, Bishoff JT et al (1998) Holmium: YAG lithotripsy yields smaller fragments than lithoclast, pulsed dye laser or electrohydraulic lithotripsy. J Urol 159:17. doi:10.1016/S0022-5347(01)63998-3
Mosli HA, Farsi HMA, Al-zimaity MF et al (1991) Vesicoureteral reflux in patients with double pigtail stents. J Urol 146:966–999
Lojanapiwat B (2006) Colonization of internal ureteral stent and bacteriuria. World J Urol 24:681–683. doi:10.1007/s00345-006-0135-6
Roberts WW, Cadeddu JA, Micali S et al (1998) Ureteral stricture formation after removal of impacted calculi. J Urol 159:723–726. doi:10.1016/S0022-5347(01)63711-X
Acknowledgments
The Ureteric Stent Symptoms Questionnaires (USSQ) was provided by Professor Joshi HB et al. in Bristol Urological Institute, Southmead Hospital, Bristol, UK. Thanks for professor Gang Sun in Fudan University to correct the grammar and spelling error.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shao, Y., Zhuo, J., Sun, XW. et al. Nonstented versus routine stented ureteroscopic holmium laser lithotripsy: a prospective randomized trial. Urol Res 36, 259–263 (2008). https://doi.org/10.1007/s00240-008-0153-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00240-008-0153-5