Selective Placement of Ureteral Stent after Ureteroscopic Removal of Stone

Ureteral stent is commonly used after ureterscopic stone removal(URS). However, there is no definitive clinical criteria in inserting the ureteral stent after URS. Patients often complain of bladder irritative symptoms, hematuria. flank pain and additive endoscopic prodedure is necessary to remove the ureteral stent. Therefore, we studied the clinical epicacy of selective ureteral stenting only when it is required.

Of the patients who was taken URS, the following patients were exclu-ded from stent insertion ; 1) Patients who have mild hydronephrosis or symptoms less than 1week. 2) Patients who were able to insert the ureteroscope through the ureteral orifice without difficulty. 3) Patients who hardly have ureteral mucosal damage seen through the ureteroscopic field after the removal of ureteral stone. 4) Patients who did not need the additional lithoclast during the removal of ureteral stone. Other than the above patients and those with stones above the mid-ureter, a 6Fr. ureteral stent was inserted and kept for 3weeks. There were 29 unstented patients and 38 stented patients.

The average age of the non-stenting and stenting group were 37.5 years old and 39.7 years old and the average stone size were 0.68cm and 0.80cm. The average operation time was 3 minutes in the non-stenting and 8minutes(including ureteral stent insertion time) in the stenting group. Hospital stay was 3 days in both groups. Intermittent gross hematuria and irritative symptoms of the bladder was shown for 3 weeks after operation in most of the patients(32cases, 84.2%) of the stenting group while those in the unstenting group, the symptoms were relieved after2days after operation. Although mild flank pain was shown in few patients(4 cases, 13.8%) of the non-stenting group, severe pain requiring intravenous analgesics was not seen in both groups. There were no specific findings in the intravenous urography which was done at 6 weeks after operation, and no hematuria and pyuria was found in both groups.

The selective placement of ureteral stent following the ureteroscopic removal of stone did not bring specfic complications. We believe that ureteral stent insertion will minimize the inconvenience especially in patients who need to return to their everyday living immediately after operation. Thus ureteral stent insertion should be used in limited situations.