Randomized, multicenter trial of ureteral stent placement vs. stent omission after ureteroscopy for renal stones

Ureteral stent placement after ureteroscopy is a major contributor to patient morbidity. We sought to evaluate postoperative complications and quality of life (QoL) metrics comparing individuals receiving ureteral stent placement vs. stent omission after ureteroscopy.

A multicenter, randomized controlled trial was performed among patients undergoing ureteroscopy and laser lithotripsy for non-obstructing renal stones with up to 1.5 cm in total stone diameter. Ureteral access sheath use and laser technique were at the discretion of the surgeon. At case end, if no ureteral injury was observed, patients were randomized to stent placement or stent omission. Primary outcome was the 30-day occurrence of emergency department visits, unanticipated provider visits, or hospitalization. Secondary outcomes included QoL measured by the Wisconsin Stone Quality of Life (WISQOL) and the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference surveys, opiate use, and abnormal imaging findings at followup.

Of 103 patients enrolled with mean (standard deviation [SD]) stone diameter 9.6 mm (4.5), 74 were randomized to stent placement (n=36) or stent omission (n=38). Ureteral access sheaths were used in 83% and 61% of patients in the stented and unstented groups, respectively. There was no difference in rate of 30-day complications between stent and stent omission cohorts (8% vs. 11%, absolute risk difference -2%, 95% confidence interval [CI] -15%, 11%, p=0.75). Stent omission showed better adjusted pre- vs. post-surgery WISQOL scaled score (16.7, 95% CI 3.1, 30.4, p=0.02) and PROMIS 6a t-score (-8.5, 95% CI -15.3, -1.6, p=0.02). No differences between groups were observed in the cumulative opiate use, ability to return to work, symptomatic urinary tract infection, or abnormal imaging findings at followup.

Compared to ureteral stent placement, stent omission after ureteroscopy for renal stones appears to be feasible and suggests improved short-term patient-reported outcomes in selected patients. This study was limited by small sample size, and future larger studies are needed.