Ureteric stent placement with extraction string: no strings attached?

UNLABELLED: Study Type--Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Of patients treated with an indwelling ureteric stent 80-90% experience lower urinary tract symptoms that are a hindrance to health-related quality of life. The prevalence of the extraction/retrieval string after ureteroscopy for stone disease and stent placement varies significantly between surgeons and published series, but the benefits of eliminating the need for a secondary procedure such as cystoscopy and stent removal, as well as the decrease in cost to the patient are well established. Published reports have not addressed the prevalence of post-procedure related events (PREs) in patients who have received an indwelling ureteric stent with the extraction/retrieval string still intact after ureteroscopy for stone disease. By analysing PREs (Emergency Room visits, unscheduled clinic visits, and telephone calls) related to their stent or procedure for patients with and without an extraction/retrieval string, the feasibility of the extraction string can be validated and the misconceptions about their use can be alleviated.
OBJECTIVE: • To review a retrospective ureteric stent cohort with and without extraction string to compare post-procedure related events (PRE), as ureteric stent placement after endoscopic management of urolithiasis is common, but data regarding the potential benefits or disadvantages of ureteric stent placement with extraction string are sparse. PATIENTS AND METHODS: • Between June 2009 and June 2010, 293 patients underwent ureteroscopy with or without lithotripsy for stone disease. • In all, 181 patients had a unilateral procedure and underwent stent placement postoperatively. • Records were retrospectively reviewed for operative data and PRE occurring within the first 6 weeks after surgery, defined as unscheduled clinic or Emergency Room visits, or adverse event telephone calls.
RESULTS: • Of 181 patients who underwent ureteric stent placement, 43 (23.8%) included an extraction string. • In all, 34.3% of all patients had a PRE, including 37.2% and 33.3% of patients with and without extraction string, respectively (P = 0.64). • PRE occurred in men with or without an extraction string (27.8 vs 32.4%, respectively; P = 0.71) and women with or without an extraction string (44.0 vs 34.3%, respectively, P = 0.39). • PRE occurred with relatively equal frequency between men and women (P = 0.28). • Only two women (4.7%) reported removing their stent prematurely, on postoperative days 2 and 6.
CONCLUSIONS: • Ureteric stent placement with extraction string after ureteroscopy for stone disease does not seem to result in more PRE, regardless of gender. • Prospective randomised trials are needed to determine the benefits and disadvantages of ureteric stents with extraction string.