A prospective randomized controlled trial comparing nonstented versus stented ureteroscopic lithotripsy.

Area of Science:

• Urology
• Endourology
• Nephrolithiasis Management

Background:

• Ureteral stents are commonly used after ureteroscopic lithotripsy to prevent obstruction.
• The necessity and impact of ureteral stenting on patient outcomes require further investigation.

Purpose of the Study:

• To evaluate the necessity of ureteral stents following uncomplicated ureteroscopic intracorporeal lithotripsy for ureteral stones.
• To compare postoperative symptoms, analgesic requirements, complications, and stone-free rates between stented and non-stented groups.

Main Methods:

• A prospective randomized controlled trial involving 58 patients undergoing ureteroscopic intracorporeal lithotripsy (primarily with holmium laser).
• Patients were randomized into non-stented (29) and stented (29) groups.
• Postoperative outcomes including symptoms (visual analog scale), analgesic use, complications, and stone-free rates were assessed at 1, 6, and 12 weeks.

Main Results:

• Significantly greater flank pain, abdominal pain, dysuria, and frequency were reported in the stented group at 1 week (p <0.005).
• No significant differences in symptoms were observed at later follow-up points.
• Both groups achieved a 100% stone-free rate, with comparable analgesic requirements and complication rates (one hospitalization for sepsis in the stented group, one ER visit for vomiting in the non-stented group).

Conclusions:

• Routine ureteral stenting is not necessary after uncomplicated ureteroscopic intracorporeal lithotripsy with the holmium laser.
• Omitting stents leads to significantly reduced early postoperative irritative and painful symptoms without compromising stone-free status or increasing complications.
• This strategy is particularly applicable when the procedure is uncomplicated and performed without balloon dilation of the ureteral orifice.