Ureteral Stenting or No Stenting
It has been a popular and accepted surgical tradition to place a ureteral stent after performing ureteroscopy especially when performing lithotripsy for ureteral calculi. The rationale for this surgical custom is based on historical animal models, which demonstrated ureteral obstruction after ureteral dilation as well as anecdotal evidence that placement of a ureteral stent prevents postoperative renal colic, possible readmission, and theoretical prevention of postoperative stricture formation. However, this dogma has recently been challenged with emerging literature that suggests uncomplicated ureteroscopy may not necessitate ureteral stenting. Randomized control trials and meta-analyses have confirmed significant lower urinary tract symptom morbidity such as urinary frequency, urinary urgency, dysuria, hematuria, and loin pain associated with ureteral stenting as well as the absence of long-term benefits to stenting (ureteral stricture prevention, improved stone-free rates, etc.). Although the randomized control trials suggest that routine ureteral stenting is not mandatory for uncomplicated ureteroscopy, the evidence does not adequately define the term “uncomplicated.” Furthermore methodological inconsistencies among different studies prevent conclusive recommendations for urologists. This chapter summarizes the literature and provides guidelines for the practicing urologist on the role of unstented ureteroscopy and suggests future directions for research in this topic.
KeywordsInternational Prostate Symptom Score Ureteral Stone Stented Group Ureteral Stents Ureteral Stricture
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