Login to Access Video or Poster Abstract: MP75-05
Sources of Funding: None

Introduction

Does short-term ureter stenting using an external ureter catheter (UC) for 6 hours following ureterorenoscopic stone extraction (URS) provide an equivalent outcome in comparison to postoperative double-J (DJ) ureter stenting?

Methods

Between 08/2014 and 08/2015, 141 patients initially treated with a DJ insertion for 7 days were prospectively randomized to UC for 6 hours vs DJ insertion for 3-5 days after stone extraction via URS (incl. flexible URS) in a single academic center. Exclusion criteria were acute urinary tract infection, a solitary kidney or a stone mass more than 25mm. Study endpoints were ureter-stent related symptoms and pain assessed by a validated questionnaire (USSQ) and visual analogue scale (VAS) before and 3-5 weeks after surgery. Parameters of both groups were compared using unpaired t-test. Level of significance was p<0.05. BMI, stone size, age, and need for analgetics, reintervention rate and comorbidities were recorded.

Results

Endoscopic procedures performed by 9 surgeons resulted in more than 90% stone removal in all cases (n=141) in a mean operation time of 24 minutes (range 5-63 min). Groups did not differ in mean age (48 years), mean BMI (28.1) and stone size (5.4 mm). Patients, who received short-term UC, showed a significant higher quality of life (USSQ) compared to patients with a long-term DJ: In the UC group the urinary index score was significantly lower (16.8 vs. 27.8; p <0.0001) as well as the pain score (9.7 ± 1.3 vs. 20.2 ± 1.5; p<0.0001) and general health index (15.3 ± 0.7 vs. 8.5 ± 0.6; p<0.0001). Consultation of a physician and antibiotic treatment were rarely needed (1.3 ± 0.1 vs. 1.6 ± 0.1; p=0.027). The UC study group returned to work earlier (3.0 ± 0.8 days) compared to the DJ study group (7.0 ± 0.9 days; p<0.0009). Furthermore, most of the UC population (88.3%) recommended treatment and would prefer an UC in case of another stone treatment in the future. Only two patients of the UC study group reported prolonged complaints lasting 2 days. No re-intervention was needed in both groups during the follow-up of 6 weeks.

Conclusions

In patients who had a DJ prior to secondary ureteroscopic stone removal postoperative short-term ureteral stenting should be standard of care rather than routine DJ insertion.

Funding

None