Is a ureteral stent required before flexible ureteroscopy?

Background: To retrospectively evaluate the therapeutic effectiveness and safety of flexible ureteroscopes without preoperative ureteral stent placement.

Methods: A total of 243 patients who had undergone flexible ureteroscopy (fURS) lithotripsy were reviewed. The patients were divided into two groups: 119 patients without preoperative ureteral stent placement were set as group A; and the remaining 124 patients who received preoperative ureteral stent placement were set as group B. The operative time, length of hospital stay, hospital costs, stone-free rates (SFRs), complications, and re-operation rates of the two groups were respectively compared.

Results: Pairwise analysis indicated the following: the average operative time of group A was longer than that of group B (66.53±10.19 versus 59.85±9.85 min, P=0.0001), the average length of hospital stay of group A was considerably shorter than that of group B (6.56±0.90 versus 10.67±1.50 d, P=0.0001), the SFRs of group A were significantly lower than those of group B at 3 days postoperatively (36.1%, 43/119 versus 51.6%, 64/124, P=0.0034), and the average hospital costs were substantially lower in group A than those in group B (18,756 versus 23,450 RMB, P=0.0001). However, there were no notable differences observed in the following: SFRs between the groups at 1 month postoperatively (84.0%, 100/119 of group A versus 85.5%, 106/124 of group B, P=0.895), complications rates (20.1%, 26/124 in group A versus 20.1%, 23/114 in group B, P=0.597), and re-operation rates (15.1%, 18/119 in group A versus 16.9%, 21/124 in group B, P=0.558).

Conclusions: These results indicated that fURS without preoperative ureteral stent placement is safe and effective for the treatment of upper urinary calculi.