Ureteral Stent Placement During Shockwave Lithotripsy: Characterizing Guideline Discordant Practice

To describe utilization patterns of ureteral stent placement during extracorporeal shockwave lithotripsy (ESWL).

The Healthcare Cost and Utilization Project State Inpatient and Ambulatory Surgery Databases for Florida (2010-2012), Iowa (2010-2012), California (2010-2011), and New York (2006-2012) were used to identify patients undergoing ESWL with or without concomitant ureteral stent placement. Multivariate logistic regression was used to identify factors associated with ureteral stent placement. Postoperative ER visits and reoperation were compared between groups with multivariate logistic regression.

A total of 128,040 patients undergoing ESWL during the study period were identified. Concomitant ureteral stent placement during ESWL was performed in 20,800 (16.2%) cases. Stent placement was more common among older patients (odds ratio [OR] 1.003 per year, 95% confidence interval 1.002-1.004) and those with greater comorbidity burden (OR 1.10, 1.09-1.11), but also among those with higher income (OR 1.13, 1.08-1.19) and private insurance (OR 1.05, 1.01-1.10). Patients undergoing concomitant ureteral stent placement had higher rates of 30-day postoperative ER visits (8.9% vs 7.3%, P<.0001) and 90-day reoperation (13.4% vs 8.2%, P<.0001) compared to patients undergoing ESWL alone.

A significant portion of patients treated with ESWL undergo concomitant ureteral stent placement, despite clinical guidelines over the last 2 decades discouraging this practice. Use of ureteral stent during ESWL appears driven by both clinical and nonclinical factors. Ureteral stent placement confers no perceivable advantage in postoperative ER visits or reoperation after ESWL based on administrative data from the Healthcare Cost and Utilization Project.