To stent or not to stent? That is still the question

Background and Purpose: Most patients are stented after ureteroscopy for stone extraction. This practice necessitates a second procedure to remove the stent, with its inherent morbidity. The aim of our study was to determine whether routine stenting of the ureter is really necessary after ureteroscopy. Patients and Methods: This prospective study evaluated 26 men and 18 women admitted for elective distal ureteral stone fragmentation. The stones ranged in size from 6 mm to 1 cm. Of the series, 16 patients (10 men) had been stented prior to ureteroscopy. A 9F semirigid ureteroscope was used in 31 cases, and a 7.5F semirigid ureteroscope was used in the other 11 cases; there was no need for ureteral orifice dilatation with either ureteroscope. Ballistic intracorporeal lithotripsy was performed in all cases with the Swiss Lithoclast(TM); all stone fragments were retrieved with a 3F helical basket. The patients were followed up as inpatients for 26 hours and reviewed in the clinic 1 week later with a request to report if they felt significant discomfort or loin pain or became feverish. Results: Only one patient (male) had to be readmitted with loin pain. Two others (both women) complained when they attended for follow-up of having had dull lower abdominal pain and some frequency. Conclusions: The low incidence of complications in this preliminary study suggests that routine stenting is not necessary after ureteroscopy. The chief exception to this statement is patients who had a difficult and prolonged stone fragmentation.