One of the challenges facing postprocedural ureteroscopy is whether to place a ureteral stent at the completion of the procedure. And if a stent is placed, what should be considered concurrently and postoperatively to manage any symptoms of stent discomfort. Much goes into that decision process, so this group was assembled for a panel discussion in San Antonio to discuss the opportunities and considerations.

Jessica Dai, MD, urologist with Evergreen Health, addressed “Can we avoid them?” She stated that stentless ureteroscopy is underutilized, but in the appropriately select patient it is safe and may minimize bothersome urinary symptoms for patients undergoing ureteroscopy. In some cases stents may not be necessary, such as when the procedure is simple and there is no blockage in the ureter. However, stents are often used in more complex cases, such as an embedded stone in the ureter or when the ureter sustains injury during the procedure.

Can we predict who won’t tolerate them? According to Karen Stern, MD, associate professor at Mayo Clinic Arizona, certain patient characteristics are associated with increased stent pain such as young age, history of depression, or history of chronic pain. Physiologic reasons for increased pain in patients, including central sensitization or hypersensitivity issues, can also contribute to the likelihood of the patient suffering from disruptive symptoms.

Focusing on whether certain stents fit some patients better than others is the purview of Etienne Keller, MD, associate professor at University Hospital Zurich. The stent that is right for one patient may not be right for another patient. He states that silicone double J stents and so-called ‘‘soft’’ double J stents can reduce stent-related symptoms compared to nonsilicone polymers and ‘‘hard’’ double J stents. Controversial data exist in the literature concerning the potential benefits that stent length, width, body shape, and distal segment can contribute. How new biomaterials, coatings, and designs may impact the individual tolerance of stents needs to be verified, but thus far no robust evidence supports the superiority of one of these modifications over conventional stents.

What can be done to mitigate stent symptoms if one is deployed? Shubha De, MD, associate professor at the University of Alberta, states that stent pain reduction strategies start in the clinic by setting expectations: patient assessments, goal setting, and access to educational resources can be deployed preoperatively. Multimodal symptomatic control improves lower urinary tract symptoms, pain, and patient satisfaction, and that can include medications such as anticholinergics or α-blockers.

Stentless ureteroscopy is underutilized and should be considered if applicable. In the appropriately selected patient, if a stent is required we have processes to predict who might be more bothered preoperatively. Consideration for correct stent size and materials intraoperatively to minimize bothersome urinary symptoms can be made. Setting expectations, with the use of medications when warranted, can postoperatively improve the quality of life for those patients who do need a ureteral stent. Timothy Averch, MD, professor at the University of South Carolina, summarizes that whether a stent is placed or not, providing thoughtful allowances in care pathways can provide post-ureteroscopy patients with the ideal care.