Ureteric Stents Compromise Stone Clearance After Shockwave Lithotripsy For Ureteric Stones: Results Of A Matched-Pair Analysis

Main Category: Urology / Nephrology
Article Date: 05 Apr 2009 - 1:00 PDT

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UroToday.com - In this study, 45 patients with ureteric stents undergoing extracorporeal shockwave lithotripsy (ESWL) for ureteral calculi (77% in the proximal ureter) were matched to patients with similar size and location of stones albeit without stents. ESWL was performed on a Sonolith Vision lithotripter. Overall, a stone free state was achieved more commonly (odds ratio of 6.0, p < 0.016) if there was no stent (93% vs. 71% stone free rate with a stent in place)!

What is the take home message? First, stents should be placed whenever it is necessary to drain the obstruction either due to urosepsis or pain unrelieved by narcotics; however, in all other circumstances with ureteric stones < 1.5 cm, no stent should be placed. Two reasons for these results may be the lack of peristalsis that occurs within 48 hours with a stent in place and possible changes in energy delivery to the stone due to the adjacent stent. Given these findings, one could well make the case for considering stent removal either immediately prior or one to two days prior to ESWL. One wonders if the authors could do a subanalysis of their large series to see if patients with a stent removed within 3 days of lithotripsy fare similarly to those who have had no stent placed?

Argyropoulos AN, Tolley
BJU Int. 2009 Jan;103(1):76-80
10.1111/j.1464-410X.2008.07886.x

Written by UroToday.com Medical Editor Ralph V. Clayman, MD

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