Introduction: Urologists often place temporary indwelling ureteral stents after ureteroscopy, but little is known about ideal stent dwell time and we lack rigorously-gathered data about tolerance. We are seeking to study the effect of stent duration on patient-reported outcomes by having patients remove their stent at three vs. seven days postoperatively, and then conducting a phone survey to assess outcomes.
Methods: Patients undergoing uncomplicated ureteroscopy for stone disease are screened for eligibility. Exclusion criteria include bilateral ureteroscopy, solitary kidney, need for additional procedure, or pregnancy. Patients are randomized to remove the stent at home either three or seven days after surgery. A few days after scheduled removal, an independent clinical research associate calls to collect data regarding stent tolerance, removal, and unscheduled calls or ER visits.
Results: To date, 80 patients have been randomized to either three (n=44, 55.7%) or seven (n=35, 44.3%) days. Seventy-two (90%) have been successfully contacted. Nearly 80% reported removal on the planned day. A prior ureteral stent was present in 31 patients (44.2%) and a ureteral access sheath was used in 33 cases (47.1%). Thirteen patients (18.6%) reported no problem with their stent, while 55 (64.3%) reported mild or moderate bother and 12 (17.2%) described either severe bother or absolute misery. Only four patients (5.8%) required narcotics for greater than two days after removal. While most patients (n=56, 80%) experienced 30 minutes or less of severe pain (impaired function) after removal, 11 (15.7%) reported this pain for greater than six hours. More patients (n=27, 38.5%) experienced mild/moderate pain ("bothersome but not limiting") for greater than six hours. Significantly more patients without a prior stent reported at least a moderate bother compared to those with one (61.5% vs 25.8%, p=0.006) and more patients without sheath use visited the ER than those with (33% vs 11.1%, p=0.04). Insufficient patients have been accrued thus far to address the question of 3 vs 7 day stent duration.
Conclusions: Most patients adhere to planned stent removal date, tolerate the stent well, do not call a provider or visit the emergency department, and do not experience severe pain following stent removal. The most common issue after stent removal is self-limited pain. Patients with a prior stent report less discomfort, and when an access sheath is used, patients are less likely to present to the ED. These numbers can help counsel patients regarding home ureteral stent removal and guide future efforts to optimize stent use.
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