Open Access

ARTICLE

Considerations in ureteral stent selection in order to minimize symptoms

Rathika R. Ramkumar¹, Sasha Vereecken², Tyler Williams³, Smita De¹

1 Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
2 Saint James School of Medicine, Chicago, Illinois, USA
3 Colby College, Waterville, Maine, USA
Address correspondence to Dr. Rathika R. Ramkumar, Glickman Urologic and Kidney Institute, Room Q10-1, 9500 Euclid Avenue, Cleveland Clinic, Cleveland, OH 44195 USA

Canadian Journal of Urology 2022, 29(4), 11231-11242.

Abstract

Introduction: Ureteral stent-related symptoms are common after stent placement. Various characteristics of stent design have been previously investigated to mitigate this issue. Our review summarizes available literature on stent design parameters (diameter, material, position, length, distal loop modifications) and their effect on stent-related symptoms, including pain.
Materials and methods: We identified articles from PubMed, Medline, EMBASE, Web of Science, and Grey Literature using a search strategy employing MESH search headings (i.e., ureteral stent diameter, length, composition, material, durometer, and stent-related pain).
Results: Out of 2,970 identified studies, 26 met eligibility criteria. Most diameter studies found patients with > 6Fr stents reported significantly increased stent-related symptoms. A few did report more migration with thinner stents. Almost half of durometer studies found composition made no difference in symptoms. Distal loop modification studies found minimizing intravesical material decreased stent-related pain. All studies on positioning found patients reported more severe urinary, pain and quality of life symptoms when stents crossed the bladder midline. No difference in stent-related symptoms was seen between multi-length and standard stents patients.
Conclusion: Adverse symptoms occur commonly after ureteral stent placement. No definitive recommendations on the model stent can be provided due to the heterogeneity of studies. Though the number of robust studies is limited, data suggest stents crossing midline, larger diameters, and those without distal material-reduction modifications may worsen stent-related symptoms. Future studies are needed to better understand the ideal stent design.

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