Is the Liberal Use of Double-J Ureteral Stents Justified for Outpatient Extracorporeal Shock Wave Lithotripsy?
The liberal use of double-J ureteral stents has been encouraged at the Bay Area Renal Stone Center in an effort to prevent complications and avoid hospitalizations and auxiliary procedures following extracorporeal shock wave lithotripsy (ESWL*) utilizing a Dornier HM3 lithotripter. The rationale for the frequent use of double-J stents resulted from several factors. When this outpatient ESWL center opened, ESWL generally was considered an inpatient procedure. The large number (90) of treating urologists initially had limited experience in ESWL. The Stone Center serviced a large geographic area (radius 150 miles) with a significant number of patients requiring substantial travel time following the shock wave procedure.
Seven hundred eighty-three consecutive patients with an adequate three-month follow-up were retrospectively evaluated. Forty-four percent of the patients required double-J stent insertion prior to the ESWL date for a variety of reasons (i.e., colic, obstruction, or urosepsis). Twenty-eight percent of patients had stents inserted immediately prior to the ESWL with an additional 8% requiring ureteral catheters for stone manipulation or for improved visualization of stones.
Of patients with stents, 2.6% required parenteral injections of pain medications post ESWL. The post-ESWL hospitalization rate of patients with stents was only 4.3%, and the post-ESWL auxiliary procedure rate was 1.7%. Retreatment was required in 3.8% of patients.
In this series, and with the outpatient approach to treatment, the liberal use of double-J ureteral stents appears to have been justified. The disadvantages of stents and future considerations of their prior use also are discussed.
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