Is stenting required before retrograde intrarenal surgery with access sheath

Area of Science:

• Urology
• Endourology
• Nephrolithiasis Management

Background:

• Flexible ureterorenoscopies are increasingly used for kidney stone treatment.
• Prior ureteral stenting is common to facilitate scope passage.
• This study investigated avoiding prior stenting in retrograde intrarenal surgery (RIRS).

Purpose of the Study:

• To evaluate the feasibility and outcomes of single-stage RIRS without prior ureteral stenting.
• To determine if omitting pre-stenting impacts procedure success or stone clearance.

Main Methods:

• 55 renal units underwent RIRS for stones (8-22 mm).
• Lower ureter dilation to 14 FR, followed by 10/12 Fr access sheath insertion.
• Flexible ureteroscope (7.5/9.3 Fr) used for holmium laser lithotripsy.

Main Results:

• Successful ureteroscope passage in 94.5% of cases without prior stenting.
• Stone-free rate of 94.3% at 3-month follow-up.
• Only 5.4% required staged procedures due to dilation failure.

Conclusions:

• Single-stage RIRS is effective for a majority of patients.
• Omitting pre-stenting does not compromise stone clearance or increase morbidity.
• This approach simplifies the management of kidney stones.