Session: MP35: Stone Disease: Surgical Therapy (including ESWL) II
MP35-01: A Single Centre Prospective Randomized Controlled Study To Assess Outcomes And Complications Of Conventional Stent Placement Versus No Stent Placement after Ureteroscopy For Distal Ureteric Calculus Of Size < 1 cms.
Introduction: Most Endo-urologists routinely insert ureteric stents, justified by the hypothetical fact that stent placement promotes the passage of residual stone fragments and clots, presumably lowers the risk of stricture formation, and prevents ureteric obstruction and renal colic induced by ureteric oedema We aimed to compare the efficacy, safety and morbidity of No stent placement with the conventional stent placement after uncomplicated retrograde semi rigid URSL for distal ureteric calculus of size < 1 cm pertaining to Lower Urinary tract symptoms and Sexual function using validated questionnaires. In addition, to compare complication rate, emergency visits, secondary interventions and pain at the time of follow up using visual analog scale (VAS) between the two groups. Methods: 104 patients were randomized following an uncomplicated ureteroscopic lithotripsy into Conventional stented Group (CSG) and non-stented group (NSG). Lower urinary tract symptoms and sexual function were evaluated using validated questionnaires (IPSS+IIEF-5+MSHQ-EjD/ FSFI) preoperatively and at 4 weeks during follow up/ stent removal based on the group. Pain scores at follow up/ stent removal were recorded using a visual analogue scale (VAS). Patients who had emergency room visits, need for secondary interventions before the recommended time of follow up were noted. Generalized Estimating Equations method was used to explore the difference in change in the domains of IPSS, IIEF-5, MSHQ-EjD and FSFI between the two groups over time. Results: Significant difference was noted in the following IPSS domains: Frequency, Urgency, Nocturia, Storage symptoms, Total IPSS Score (p = <0.001) and QoL (p = 0.002), IIEF-5 domains: Overall Score (p = 0.004), MSHQ-EjD domains, Ejaculation Bother/ Satisfaction (p = <0.001) and FSFI domains: Lubrication (p = <0.001), Satisfaction (p = 0.006) and Overall Score (p = 0.004). There was no significant difference between the various groups in terms of distribution of Emergency Visits, Readmission and Secondary Interventions, pain at follow-up (VAS) and long-term analgesia. Variable CSG Group (n=49) NSG Group (n=43) p-Value ?2 Emergency visits 7(14.3%) 5 (11.6%) 0.706 0.143 Readmissions 4 (8.2%) 1 (2.3%) 0.367 1.519 Secondary Interventions Conservative Management 0 (0.0%) 1 (2.3%) 0.467 1.152 Early stent removal 3 (6.1%) NA - - PCN Insertion 0 (0.0%) 0 (0.0%) - - Relook URS 1 (2.0%) 0 (0.0%) 1.000 0.887 Analgesia requirement (> 5 days) 11 (22.4%) 5 (11.6%) 0.172 1.867 Variable CSG Group (n=49) NSG Group (n=43) p-Value ?2 Emergency visits 7(14.3%) 5 (11.6%) 0.706 0.143 Readmissions 4 (8.2%) 1 (2.3%) 0.367 1.519 Secondary Interventions Conservative Management 0 (0.0%) 1 (2.3%) 0.467 1.152 Early stent removal 3 (6.1%) NA - - PCN Insertion 0 (0.0%) 0 (0.0%) - - Relook URS 1 (2.0%) 0 (0.0%) 1.000 0.887 Analgesia requirement (> 5 days) 11 (22.4%) 5 (11.6%) 0.172 1.867 Conclusions: Non placement of stents after uncomplicated URS decreases stent related symptoms, improves QoL without jeopardizing for an increased postoperative risk. SOURCE OF Funding: Nil
