Open Access

ARTICLE

Clinical and postoperative characteristics of stentless ureteroscopy patients: a prospective analysis from ReSKU

Fadl Hamouche, Rei Unno, Nizar Hakam, Leslie Bernal Charondo, Heiko Yang, Justin Ahn, David B. Bayne, Marshall L. Stoller, Thomas Chi

Department of Urology, University of California San Francisco, San Francisco, California, USA
Address correspondence to Dr. Thomas Chi, Department of Urology, University of California, San Francisco, 400 Parnassus Ave., Sixth Floor, Suite A610, San Francisco, CA 94143 USA

Canadian Journal of Urology 2023, 30(3), 11532-11537.

Abstract

Introduction: To evaluate the clinical characteristics as well as the postoperative course of urolithiasis patients undergoing a ureteroscopy (URS) without stent placement.
Materials and methods: This was a prospective case cohort study utilizing data collected in the Registry for Stones of the Kidney and Ureter (ReSKU) from a single institution between October 2015 and December 2020. We identified all consecutive patients undergoing URS for stone disease and analyzed data encompassing demographics, medical history, intra and postoperative characteristics, including complications and postoperative symptoms. Univariate and multivariate logistic regression analyses were performed based on the presence or absence of an indwelling ureteral stent.
Results: A total of 470 patients were included for analysis, 92 patients in the stentless group (19.5%). Factors associated with stentless ureteroscopy were a lower stone burden (p < 0.001), the pre-existence of a ureteral stent (37.4% vs. 27.9% p = 0.011), absence of an access sheath (14.6% vs. 69.5% p < 0.001), and a shorter operative time (31 vs. 58 min p < 0.001). Postoperative gross hematuria and lower urinary tract symptoms (LUTS) were reported less frequently in stentless patients (p = 0.02, p = 0.01, respectively). There was no difference in postoperative complications between both groups (15.2% vs. 12.0%, p = 0.385). On multivariate analysis, the risk of postoperative complications was associated with obesity, stone burden ≥ 1 cm, and positive preoperative urine culture. There was no patient who required emergent stent placement in the stentless group.
Conclusion: Our data show that, in well selected patients, omitting ureteral stent placement after URS can decrease postoperative gross hematuria and LUTS without increasing postoperative complications.

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