Stent less Ureteroscopy abates post-operative Hematuria and LUTS in nephrolithiasis patients

New research That was published in The Canadian Journal of Urology shows that avoiding ureteral stents after ureteroscopy can reduce postoperative gross hematuria and lower urinary tract symptoms in selected patients without increasing any post-operative complications. 

Urolithiasis is a common condition that accounts for multiple hospital visits. Poor oral fluid intake, and high intake of animal-derived protein, oxalate, and salt causes the collection of the stones in ureters, bladder, and urethra leading to Urolithiasis. Ureteroscopy is one of the common methods used to visualize the urinary tract and retrieve the obstructing stone. Foregoing ureteral stents after ureteroscopy is a developing practice. There is uncertainty about the stentless ureteroscopy procedure. Hence researchers from the Department of Urology, the University of California San Francisco, San Francisco, California, USA conducted a prospective case-cohort study to evaluate the clinical characteristics as well as the postoperative course of urolithiasis patients undergoing a ureteroscopy (URS) without stent placement.  

The study was carried out by utilizing data collected in the Registry for Stones of the Kidney and Ureter (ReSKU) from a single institution between October 2015 and December 2020. All consecutive patients undergoing URS for the stone disease were identified and their data encompassing demographics, medical history, intra, and postoperative characteristics, including complications and postoperative symptoms, was analyzed. Univariate and multivariate logistic regression analyses were performed based on the presence or absence of an indwelling ureteral stent. 

Results: 

Out of 470 patients who were included in the analysis, 92 patients were in the stentless group (19.5%).

A reduced stone burden, the presence of an existing ureteral stent, the lack of an access sheath, and a shorter operating time were factors related to stent-less ureteroscopy. 

Stent-less patients reported less Postoperative gross hematuria and lower urinary tract symptoms (LUTS). 

There was no difference in postoperative complications between both groups (15.2% vs. 12.0%, p = 0.385).

The risk of postoperative complications was associated with obesity, stone burden ≥ 1 cm, and positive preoperative urine culture On multivariate analysis.

No patient required emergent stent placement in the stentless group. 

Thus, It is possible to reduce postoperative gross hematuria and LUTS in carefully chosen individuals by forgoing ureteral stent insertion after URS without increasing postoperative complications. 

Further reading: Hamouche F, Unno R, Hakam N, et al. Clinical and postoperative characteristics of stentless ureteroscopy patients: a prospective analysis from ReSKU. Can J Urol. 2023;30(3):11532-11537.