Ureteral Stenting After Ureteroscopy for Stone Treatment, A Global Perspective on Indications and Outcomes

BACKGROUND AND RATIONALE

The majority of patients with stones receive an indication for its active removal by
ureteroscopy. In the last two decades, endourological treatment techniques have evolved with
several technological advances through miniaturisation of ureteroscopes, digital
improvements, and optical imaging enhancement techniques leading to a better image quality,
and the development of different disposables such as single-use digital ureteroscopes. This
advancement has led to an increased number of indications for ureteroscopic treatment. Aside
from this, there are no specific contraindications for ureteroscopic treatment, apart from
general problems such as being unfit for anaesthesia or the presence of urinary tract
infections, according to the EAU guidelines.

The indications for active stone removal of ureteral stones include persistent pain or
obstruction, renal insufficiency, and in cases when spontaneous passage is less likely. The
indications for active removal of renal stones include stone growth, stone formation in
patients who are at high risk for stone formation, symptomatic patients, infection,
obstruction, stones larger than 15 mm and the comorbidity profile, social situation and
preference of the patient.

The procedure can be performed using semi-rigid instruments, mainly for ureter stones, and/or
by flexible ureteroscopes, for complete inspection and treatment of the upper tract.

The exit strategy after stone treatment varies depending on patient characteristics and
comorbidity, residual stone load, per-operative details and complications, and surgeons'
preference. Stent placement is recommended by the EAU guidelines in case of increased
postoperative complications; in cases of residual fragments, bleeding, perforation, pregnancy
or urinary tract infections; as well as in all doubtful cases to avoid stressful emergencies.

Postoperative stenting increases postoperative morbidity and urologists should carefully
balance the pros and cons of postoperative stenting in each individual case. The ideal stent
duration is not known. Ureteral stents are usually removed 1-day postoperatively and most
urologists will remove double Js 1-2 weeks postoperatively.

It remains a matter of debate whether to stent a patient postoperatively after a
ureteroscopic procedure despite the EAU guidelines statement that routine stenting after an
uncomplicated procedure with complete stone removal is not necessary.

STUDY OBJECTIVES

The aim of this registry is to review current clinical practice on postoperative ureteral
stenting after ureteroscopy for stone treatment. The investigators will explore the answers
to the following questions: What are the indications, predictors and outcomes for stent
placement? What types of stents are used and what is the duration for stent placement? Hence,
the investigators will assess in what setting the stents are being removed, looking at
instrumentation, anaesthetics, and location.

Inclusion Criteria:

- Patient >18 years old

- Patient is a candidate for ureteroscopic treatment of a ureter or renal stone by
semi-rigid and/or flexible ureteroscopy

Exclusion Criteria:

- Patient <18 years old