Digital tracking of ureteral stents with the stentless application: clinical outcomes in 200 patients

Ureteral double-J stents (UDJS) are frequently placed in urologic practice for a range of indications, including ureteral obstruction, strictures, stone disease, peri- and post-ureteroscopy, and following ureteral reconstruction or reimplantation. Recent studies suggest that approximately 13% of inserted stents become overdue or neglected, which can lead to serious, potentially life-threatening complications. We therefore aimed to develop a smartphone application to track patients with UDJS and reduce the incidence of overdue indwelling ureteral stents.

For the development of the application, we worked with a specialized team of programmers. To facilitate universal access to the complete patient database, a cloud-based database was implemented. The application was designed to send a Short Message Service (SMS) to the patients and their general practitioner to remind the timing for UDJS extraction. We prospectively enrolled a total of 200 patients who underwent UDJS insertion for any indication by six urologists from June 2023, to March 2024. The patients were divided into two groups: the first group was monitored using the Stentless mobile application, while the second group was monitored using an electronic patient registry. The two groups were compared with respect to stent overdue times and complete loss-to-follow-up rates.

In this study, a total of 200 patients were enrolled non-randomly and assigned to one of the study groups. 100 patients assigned to group 1 (mobile application group) and 100 to group 2 (electronic registry group). Among these, 187 patients (93.5%) underwent unilateral ureteral stent placement, while 13 patients (6.5%) required bilateral stent placements. The study also included patients with long-term indwelling stents, with the maximum stent replacement interval extending up to 360 days. The median indwelling time across the cohort was 17 days (range 14-360), reflecting the inclusion of long-term stents. In group 1, no patients missed their scheduled stent removal appointments, corresponding to an LTFU rate of 0% and no overdue removals. In group 2, four patients failed to attend their scheduled appointments (p = 0.121). These patients were identified through the electronic patient registry and subsequently contacted for follow-up. The delay in stent removal among these four patients was (7, 10, 13, and 60 days) beyond the planned appointment date. Notably, one patient from group 2 presented with an encrusted stent requiring two flexible ureteroscopy procedures for removal. Ultimately, all ureteral stents were successfully removed in an office-based setting, ensuring complete management for all participants.

By notifying the patient and general practitioner with a mobile phone text message automatically transmitted from the application, there is the potential to increase patient compliance, reduce the rate of those who have a UDJS and fail to return for follow-up, respectively to reduce the rate of patients presenting for complications due to stent encrusting.