Prestenting improves ureteroscopic stone-free rates

Purpose: Although the use of stents after ureteroscopy has been studied extensively, relatively little has been published about stent placement before complicated ureteroscopic procedures. In this study, we examined our experience with stent placement before ureteroscopic management of renal and ureteral stone disease. Patients and Methods: A total of 90 patients underwent ureteroscopic surgery on 115 renal units by a single surgeon from 2001 to 2006. All patients had documented follow-up with imaging either by CT or intravenous urography (IVU) with tomography. Patients were classified into two groups depending on whether they had a stent placed before ureteroscopy. Baseline characteristics, operative indications for stent placement, stone-free rates, and complications were compared between groups. Results: Baseline characteristics were similar between the groups. The majority of patients received stents before stone management because of technical considerations during surgery (17/ 36, 47%) or infection (13/ 36, 37%). Strict stone-free rates after ureteroscopic treatment were 47% in the 79 procedures without previous stents, compared with 67% in the 36 procedures with prestenting ( P < 0.05). Including small fragments ( 2 mm or smaller), stone-free rates improved to 54% v 78%, respectively ( P < 0.02). Complications were not significantly different in the two groups ( P < 0.70). Conclusion: Although routine stent placement is not necessary before all ureteroscopic procedures, we demonstrate that it is associated with good stone-free rates and few complications. In this retrospective cohort, prestenting was associated with significantly higher stone-free rates. Prestenting should be considered in challenging cases.