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JU INSIGHT What Is the Optimal Stenting Duration After Ureteroscopy and Stone Intervention?
By: Khurshid R. Ghani, MBChB, MS, FRCS(Urol)*, University of Michigan, Ann Arbor; Oluyemi O. Olumolade*, University of Michigan, Ann Arbor; Stephanie Daignault-Newton, MS, University of Michigan, Ann Arbor; Adam Cole, MD, Smith Institute for Urology, Northwell Health, New Hyde Park, New York; Patrick Yang, DO, Michigan State University College of Human Medicine, Michigan Health Care Professionals, Farmington Hills; Susan Linsell, MHSA, University of Michigan, Ann Arbor; Brian Seifman, MD, Michigan Institute of Urology, Beaumont Hospital, Royal Oak; Dave Wenzler, MD, Michigan State University College of Human Medicine, Michigan Health Care Professionals, Farmington Hills; Casey Dauw, MD, University of Michigan, Ann Arbor | Posted on: 19 Sep 2023
For the Michigan Urological Surgery Improvement Collaborative
*Co-first authors.
Ghani KR, Olumolade OO, Daignault-Newton S, et al. What is the optimal stenting duration after ureteroscopy and stone intervention? Impact of dwell time on postoperative emergency department visits. J Urol. 2023;210(3):472-480.
Study Need and Importance
The AUA stone management guidelines recommend minimizing the duration of stenting after ureteroscopy to reduce morbidity, and stents with extraction strings may be used for this purpose. However, there are limited data on stenting dwell time and its impact on outcomes such as unplanned health care encounters. Using real-world practice data from the Michigan Urological Surgery Improvement Collaborative, we investigated the association between dwell time and string status on postoperative emergency department (ED) visits on the day of or day after stent removal.
What We Found
We analyzed 4,437 unilateral ureteroscopy and stenting procedures in nonpre-stented patients; 38.1% had an extraction string placed, and there was significant surgeon variation in the use of this method. Patients with extraction strings had shorter dwell times. Dwell time of 0-4 days was significantly associated with an increased risk of ED visit occurring around the time of stent removal. There was no statistically significant increase in risk of ED visits in patients with a string if dwell times were ≥5 days (see Figure).
Limitations
Data on the stent composition, size, and how the extraction string was managed were not available. Reasons why providers chose stents with strings were not captured, and it is possible that higher-risk patients or those with a history of stent intolerance were more likely to receive such stents. We are also unaware if the instruction to have a short dwell time is surgeon or patient driven, or because of stent-related symptoms.
Interpretation for Patient Care
In Michigan, ureteral stent dwell time of 4 days or less is associated with an increase in postoperative ED visits around the time of stent removal. In nonpre-stented patients undergoing ureteroscopy and stone intervention, we recommend a minimum dwell time of at least 5 days.
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