Ureteral stents are used to bypass obstructive stones, to dilate the ureter in order to facilitate ureteroscopy (URS), and to maintain patency / low intrarenal pressure following stone surgery. However, there can be morbidity (pain / voiding symptoms). Tasian et al. studied the impact of primary ureteral stent placement on individuals (<24 years of age) undergoing URS or extracorporeal shockwave lithotripsy (ESWL) at six hospitals in the USA (January 2009 – November 2021). They determined the number of emergency department (ED) visits in the 120 days following study entry (primary ureteral stent placement at the time of or within the 60 days before the primary URS / ESWL). Secondary outcome was the number of opioid prescriptions within the same period. In total, 11,838 individuals were diagnosed with kidney stones. Of these, 2093 individuals had 2477 surgical episodes (2144 were URS and 333 were ESWL). Median age was 15 years. A primary stent was placed in 1698 (79%) of URS episodes and 33 (10%) of ESWL episodes. There were 444 (18%) ED visits occurring within 120 days of surgery. Primary stenting was associated with a 33% higher rate of ED visits within 120 days of either URS or ESWL, and with a 30% higher rate of opioid prescriptions (the magnitude of association was greater for ESWL than URS). Stenting was clearly associated with an increase in postoperative ED visits and opioid prescriptions. Could stenting and opioid prescriptions have been avoided in a good number of these cases? The answer is most likely – yes. It is obviously necessary to pre-stent some smaller children for URS but attempts at primary definitive surgery (in older children) would reduce the number pre-stented. The study lacked access to clinical information that could have influenced the decision to place a stent at the time of surgery (e.g., stone size / duration of URS) or information on surgical indications (e.g., infection) or whether the stent was left on a string. The study findings provide opportunities to modify treatment, e.g., to identify situations where stents may perhaps be safely omitted or alternative analgesic regimens (e.g., paracetamol or non-steroidal anti-inflammatory drugs rather than opioids) and the use of anticholinergic medications or pain coping strategies.
Stenting prior to URS or ESWL – does it increase ED visits and opiate prescriptions?
Reviewed by Neil Featherstone
Ureteral stent placement prior to definitive stone treatment is associated with higher postoperative emergency department visits and opioid prescriptions for youth having ureteroscopy or shock wave lithotripsy.
CONTRIBUTOR
Neil Featherstone
Cambridge University Hospitals NHS Foundation Trust (Addenbrookes Hospital).
View Full Profile
