Impact of preoperative ureteral stenting on perioperative outcomes in percutaneous nephrolithotomy

The impact of preoperative ureteral stenting on perioperative outcomes in percutaneous nephrolithotomy (PCNL) remains unexplored. This study addresses this knowledge gap to guide evidence-based clinical practice.

We retrospectively analyzed consecutive PCNL patients treated at LMU University Hospital Munich between December 2012 and April 2025 (n = 374), and compared perioperative outcomes between prestented and non-prestented patients. Patients who underwent endoscopic combined intrarenal surgery (ECIRS, n = 154) or simultaneous bilateral endoscopic surgery (SBES, n = 23) were excluded to avoid confounding from concurrent ureteroscopy.

A total of 197 PCNL patients were included (median age 55 years, 64% male). Preoperative ureteral stenting was performed in 78 patients (40%), while 119 patients (60%) underwent PCNL without prestenting. No significant differences were observed between the two groups regarding age, gender, BMI, ASA score, stone radiodensity, or stone composition. Guy's Stone Score did not differ significantly between groups (median 2, IQR 1-3; p = 0.221), although prestented patients had a slightly higher stone count. Operative time (103 vs 97 minutes; p = 0.814) and complication rates (10% vs 11%; p = 0.963) were similar, with fever being the most common complication. Radiation exposure, laboratory parameters, and hospital stay did not differ between groups. On multivariable logistic regression, prestenting (OR = 2.83, 95% CI: 1.09-7.38; p = 0.033), longer operative time, Guy's Stone Score 4, and greater stone number were independent predictors of not achieving stone-free status.

Unless urgently indicated, preoperative ureteral stenting before PCNL should be omitted, because it confers additional procedural burden and stent-related morbidity without improving perioperative outcomes.