Login to Access Video or Poster Abstract: MP50-04
Sources of Funding: None

Introduction

Ureteral stenting prior to ureteroscopy (URS) has been credited with improved stone-free rates and reduced operative times; however, the AUA guidelines on the surgical management of urolithiasis advocate against routine prestenting. We chose to compare the perioperative outcomes of patients with and without a ureteral stent at the time of URS at our institution.

Methods

After IRB Approval, a retrospective review of patients undergoing semi-rigid and/or flexible URS between February 2014 and April 2016 was conducted. Patient demographics and perioperative outcomes were compared based on the presence or absence of a double-J ureteral stent prior to URS. Nurse calls, return to the emergency department and readmission within 90 days were also compared. Chi-square analysis was used for categorical data while Student's t-test was used for interval data.

Results

458 patients underwent URS during the study period. 295 patients were prestented (psURS) while 163 went directly for ureteroscopy (dURS). There was no difference in age, mean ASA score, indication for surgery or mean stone size (Table 1). PsURS had more proximal ureteral stones while dURS had more distal stones. PsURS was also more likely to have UTI prior to surgery. Prestenting did not influence operative time and psURS patients were more likely to undergo flexible URS (Table 2). The psURS cohort utilized an access sheath more often (p <0.001) and had less ureteral dilation (p<0.001). There was failure to reach the stone in 3 patients undergoing dURS vs. 0 patients with psURS (p=0.02); however, there was no difference in stone-free rates (p = 0.37). There was no increased risk of ureteral injury in the dURS cohort (p = 0.24). PsURS and dURS yielded no difference in calls to the nurse (p =0.20) and return to the ED within 90 days (p= 0.80). Readmission within 90 days was more likely after psURS (32 vs. 7 readmissions, p = 0.02).

Conclusions

Presence of a ureteral stent at the time of URS offers no advantage vs. dURS, but is associated with an increased risk of readmission within 90 days.

Funding

None