A prospective randomized multicentric study comparing stented vs non-stented ureteroscopic lithotripsy.
OBJECTIVE
We compared postoperative pain, short and long-term complications after ureteroscopic (URS) treatment of stones followed or not by placement of a double J stent.


METHODS
from July 2000 to September 2001 we recruited a total of 56 patients with ureteric stones amenable of endoscopic treatment by URS. Mean age was 48 years (22-70) average stone diam was 9.17 x 6.91 mm (15-7 x 10-5 mm). Patients were classified into obstructed or non obstructed on the basis of the intravenous pielography, and thereafter prospectively randomized in stented (6 ch DJ) or non-stented patients. 26 patients were classified as obstructed, whilst 30 as non obstructed. Therefore we have 13 patients in each branch (stented/non stented) of the obstructed group and 15 in each branch (stented/non stented) in the non obstructed group). Procedures were carried out with rigid or semirigid ureteroscopes up to 8.5 Ch and in all cases ballistic lithotripsy was used. Stented patients had the double J removed between postoperative day 3 and 10 (mean 7). By means of a visual analogic scale (VAS), postoperative pain was assessed. Patients underwent an ultrasound assessment a month 1-3 and 6 post operatively. Also early complications, if present, were recorded and analysed.


RESULTS
No statistically significant differences were reported between the groups regarding postoperative pain (p > 0.5) or persisting or newly established hydronephrosis (p > 0.5) unregarding the preoperative presence of urinary tract obstruction. In 2 cases residual fragments were present necessitating in 1 case of a second URS. In 1 case, randomized as non stented, a double J was positioned in day 1 postoperative with the aim to reduce persisting pain.


CONCLUSIONS
Ureteroscopy is a safe, minimally invasive procedure, actually the optimal treatment for ureteric stones. The positioning of a double J stent after the procedure does not have, with the actual ureteroscope size and lithotripsy devices, as is evident from our study, anymore indication.
Grossi
Francesco S
FS
Struttura Complessa di Urologia OC, Martina Franca, Italy. grossifs@libero.it
Ferretti
Stefania
S
Di Lena
Sebastiano
S
Crispino
Michele
M
D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000628:therapy*; D018666:Ureteroscopy