Category: Clinical Stones: Equipment (stents, lasers, guidewires, sheaths)

MP27-16 - Cystoscopic versus string stent extraction: analysis of morbidity and costs

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective : Indwelling ureteral stents are often placed following elective ureteroscopy.  Stent removal may be performed manually by pulling the stent string or utilizing office based cystoscopy. We attempted to better quantify the morbidity and costs associated with stent removal using the extraction string versus cystoscopy following ureteroscopy.


Methods :

We performed a retrospective analysis of 279 consecutive patients who underwent ureteroscopy and ureteral stent placement for stone disease by two endourologists  (PM & DS) at an academic center between August 2014 and August 2017. Clinical factors and post procedure events within 30 days were compared between patients who had stents placed with and without an extraction string. Associated costs were extrapolated and compared. 


Results :

145 (52%) patients had an extraction string present. There was no difference in patient age, BMI, or sex between the two groups (Table 1). Stent dwell time was significantly shorter with an extraction string (p < 0.001). Of stents without a string, 97.8% (n=132) were removed via cystoscopy in the clinic and 2.2% (3) in the operating room due to patient preference. Of stents with a string, 83% (120) were removed by the patient, 16.3% (24) by a nurse or clinician, and 0.7% (1) required office cystoscopy due to string breakage. There was no difference in overall 30 day post procedural events (p = 0.23).  Stent dislodgement (p = 0.04) was more likely with a string (p = 0.041). Median post procedural costs were $350 lower with an extraction string than without (p < 0.001). 


Conclusions :

Ureteral stents post ureteroscopy generates significant discomfort as evidenced by the large number of telephone calls. Presence of an extraction string does not increase morbidity and absence is associated with higher costs due to need for cystoscopy. 

Jeannie J. Su

Resident Physician
Yale New Haven Hospital
New Haven, Connecticut

Jeannie Su MD is a 4th year urology resident at Yale Medicine Department of Urology in New Haven, Connecticut.

Juan F. Javier-DesLoges

Resident Physician
Yale New Haven Hospital
New Haven, Connecticut

Dinesh Singh


New Haven, Connecticut

Piruz Motamedinia


New Haven, Connecticut