Introduction: Ureteral stenting is often performed following ureteroscopy (URS) for urolithiasis, however, there is no consensus on optimal timing and method of stent removal. Due to associated stent-symptoms, it is often thought that shorter stent dwell time is better. We sought to determine the impact of dwell time and planned removal strategy on the rate of post-operative emergency department (ED) visits.
Methods: Using data from the Michigan Urological Surgery Improvement Collaborative’s Reducing Operative Complications from Kidney Stones (MUSIC ROCKS) prospective clinical registry, we identified all patients undergoing primary URS with ureteral stent placement, treated between June 2016 to July 2019. Patients who were pre-stented were excluded. Ureteral stent dwell time and planned method of removal (with or without extraction string) was assessed. We determined the proportion of patients that had an ED visit within 30 days of URS, and evaluated factors associated with such a visit. Multivariable logistic regression was performed, controlling for patient and stone factors.
Results: 4445 URS with ureteral stent procedures were analyzed. Median stent dwell time was 7 days (IQR 5-13 days). 430 (9.7%) patients had an ED visit within 30 days of surgery. 1694 stents had an extraction string (38.1%), and these patients were more likely to visit the ED compared to those without a string (12.5% vs 8.0%, p<0.001). ED visits were significantly higher for patients with a stent dwell time of 0-2 days (28.1%) compared to 3-7 days (9.8%) or >7 days (8.0%) (Table 1). For patients with a short dwell time (0-2 days), there was no difference in ED visit rates for those with and without an extraction string. On multivariable analysis, extraction string use was associated with an increased odds of an ED visit (OR 1.63; 95% CI 1.31-2.02, p<0.001).
Conclusions: Short ureteral stent dwell-time is associated with increased morbidity following URS. Overall, patients with an extraction string were more likely to present to the ED. We recommend counseling to determine the appropriateness of an extraction string, and a dwell time of at least 3 days to avoid unplanned healthcare utilization after URS. Source of
Funding: Financial support for MUSIC is provided by Blue Cross Blue Shield of Michigan as part of the BCBSM Value Partnership program