title: Is ureteral stenting necessary after uncomplicated ureteroscopic lithotripsy? A prospective, randomized controlled trial.
abstract: OBJECTIVE
  We conducted a prospective, randomized controlled study to investigate the advantages and disadvantages of ureteral stenting after ureteroscopic lithotripsy.
  
  
  METHODS
  A total of 60 patients who underwent ureteroscopic lithotripsy were equally randomized into a stented or a nonstented group. The inclusion criteria were stone 6 to 10 mm., absence of polyp or stricture in the ureter and no mucosal injury during ureteroscopy. The operation was performed with a 6Fr rigid ureteroscope without ureteral dilation and stones were fragmented with a 1.9Fr electrohydraulic lithotriptor without extraction. A 7Fr double pigtail stent was placed in the stented group for 3 days after ureteroscopy. Urinalysis, plain x-ray and renosonography were performed before and after lithotripsy in each patient. Subjective symptoms and pain score were recorded on admission to the hospital and 3 days postoperatively.
  
  
  RESULTS
  The stone-free rate was 100% in each group and preoperative hydronephrosis equally resolved in both groups. Mean pain score plus or minus standard deviation improved significantly in the nonstented (6.33 +/- 1.81 preoperatively to 2.30 +/- 1.93 postoperatively, paired Student's t test p <0.0001) and stented (7.10 +/- 1.03 to 2.30 +/- 2.22, p < 0.0001) group. There was no statistical difference in pain reduction between the 2 groups (p = 0.18). The amount of extra parenteral analgesic used was similar in both groups. One patient in the nonstented group visited the emergency room for postoperative renal colic, 25 (83.3%) patients in the stented group complained of at least 1 irritative bladder symptom and only 4 (13.3%) in the nonstented group experienced bladder discomfort.
  
  
  CONCLUSIONS
  After uncomplicated ureteroscopic electrohydraulic lithotripsy patients without ureteral stenting tend to have similar renal function recovery and satisfactory pain reduction with less irritative symptoms compared to those treated with a ureteral stent. We suggest that it is not necessary to place a ureteral stent routinely after uncomplicated ureteroscopic electrohydraulic lithotripsy for stones smaller than 1 cm.
authors.affiliation: Departments of Urology, EnChu Kong Hospital and National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yung-Tai
authors.initials: YT
authors.lastname: Chen
authors.forename: Jun
authors.initials: J
authors.lastname: Chen
authors.forename: Wai-Yan
authors.initials: WY
authors.lastname: Wong
authors.forename: Stephen Shei-Dei
authors.initials: SS
authors.lastname: Yang
authors.forename: Cheng-Hsing
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Chung-Cheng
authors.initials: CC
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D017602:Lithotripsy, Laser; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000175:diagnosis / Q000628:therapy*; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000628:therapy*; D018666:Ureteroscopy