title: Is stent placement necessary after uncomplicated ureteroscopy for removal of impacted ureteral stones?
abstract: OBJECTIVE
  Ureteral stent placement after ureteroscopic lithotripsy has some advantages and disadvantages. In this randomized study, the necessity of ureteral stent placement after uncomplicated ureteroscopy for impacted ureteral stones was assessed.
  
  
  METHODS
  Between 2005 and 2007, 60 evaluable patients were equally randomized to groups with and without stents. Patients underwent ureteroscopic pneumatic lithotripsy for ureteral stones. The operation was completed with or without stent placement according to the randomization order. Excretory urography was performed 3 months after the procedure. All stents were cystoscopically removed at the third postoperative week. Sociodemographic and clinical variables (age, sex, stone location, stone size, operative time, hospital stay, narcotic and nonnarcotic analgesic use), and postoperative complications (fever, pain delaying discharge, emergency department visit, urinary retention, stent-related irritative symptoms) were evaluated.
  
  
  RESULTS
  Mean stone size was not significantly different in both groups. Mean operative time was significantly longer in the stent group: 30.5 +/- 9.6 vs 43.7 +/- 11.6 minutes. On the operation day and until postoperative day (POD) 5, narcotic (P = 0.004) and nonnarcotic analgesic (P = not significant) use was more frequent in the no-stent group. At POD 5 and later, although narcotic and nonnarcotic analgesic use were frequently necessary in the stent group, both were almost unnecessary in the no-stent patients. Stent-related irritative symptoms were overwhelmingly higher (10% vs 93%) in the stent group. Discharge was delayed (23% vs 10%) and unplanned emergency department visits (20% vs 10%) were exercised almost two times more commonly in the no-stent group. Stone-free rates were identical (n = 29/30; 97%) in both groups.
  
  
  CONCLUSIONS
  Routine placement of a ureteral stent is not mandatory in patients without complications after ureteroscopic lithotripsy for impacted ureteral stones. Stent placement can be argued and agreed with the patients preoperatively in the light of the data presented above.
authors.affiliation: Urotip Diagnosis Center, Istanbul, Turkey. cevik@renetworks.net
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Cevik
authors.forename: Ozdal
authors.initials: O
authors.lastname: Dillioglugil
authors.forename: Atif
authors.initials: A
authors.lastname: Akdas
authors.forename: Yoram
authors.initials: Y
authors.lastname: Siegel
mesh_terms: D000328:Adult; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015607:Stents; D014514:Ureteral Calculi / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods*