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UPJ INSIGHT Stent Omission in Pre-stented Patients Undergoing Ureteroscopy Decreases Unplanned Health Care

By: John Michael DiBianco, MD, University of Florida, Gainesville; Stephanie Daignault-Newton, MS, University of Michigan, Ann Arbor; Ajith Dupati, University of Michigan, Ann Arbor; Spencer Hiller, MD, AdventHealth, Orlando, Florida; Naveen Kachroo, MD, Henry Ford Hospital, Detroit, Michigan; Brian Seifman, MD, Michigan Institute of Urology, Rochester Hills; David Wenzler, MD, Comprehensive Urology, Detroit, Michigan; Casey A. Dauw, MD, University of Michigan, Ann Arbor; Khurshid R. Ghani, MD, University of Michigan, Ann Arbor | Posted on: 20 Apr 2023

DiBianco JM, Daignault-Newton S, Dupati A, et al. Stent omission in pre-stented patients undergoing ureteroscopy decreases unplanned health care utilization. Urol Pract. 2023;10(2):162-169.

Study Need and Importance

To reduce the morbidity associated with ureteral stents, the AUA stone management guidelines describe a selective approach to stenting after ureteroscopy, stating they may be omitted after uncomplicated procedures. However, the guidelines do not consider pre-stented status in these criteria. Therefore, we sought to characterize the practice of stent omission following uncomplicated ureteroscopy in pre-stented and non–pre-stented patients and its impact on postoperative health care utilization in Michigan.

What We Found

Pre-stented patients represent 36% of ureteroscopy cases in MUSIC (Michigan Urological Surgery Improvement Collaborative). While pre-stented patients more frequently have stents omitted compared to non–pre-stented patients, there was substantial variation in practice, with nearly a quarter of urologists never omitting a stent (see Figure). After adjusting for risk factors, we found that stent omission in pre-stented patients was associated with a significant reduction in postoperative emergency department visits and hospitalizations. Collectively, these findings demonstrate that pre-stented patients are ideal candidates to consider a strategy of stent omission.

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Figure. Variation in rates of stent omission for pre-stented patients undergoing ureteroscopy by urologists in Michigan Urological Surgery Improvement Collaborative (MUSIC) Reducing Operative Complications from Kidney Stones (ROCKS) practices with ≥5 uncomplicated cases. Total ureteroscopy case volume indicated by bubble size.

Limitations

The MUSIC registry includes a variety of urology practices, which enables representation of real-world data; however, the registry does not capture data on renal impairment or laboratory results, and these are thus absent from our uncomplicated ureteroscopy definition. Additionally, we do not capture the reason for stent placement or dwell time prior to ureteroscopy, and it is possible this may have impacted the urologist’s decision surrounding stenting.

Interpretation for Patient Care

There is wide variation in stent omission after ureteroscopy in pre-stented patients, and many urologists never perform it. Pre-stented patients have lower postoperative unplanned health care utilization. As such, the pre-stented patient may serve as an ideal target group for quality improvement pathways to increase the use of stent omission, with the goal to improve the patient outcomes after ureteroscopy.

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