The role of ureteral stent placement in the prevention of Steinstrasse

Background and Objective: Steinstrasse constitutes a potentially serious co mplication of extracorporeal shockwave lithotripsy (SWL). Ureteral stent pl acement has been used to prevent Steinstrasse after fragmentation of larger stones. However, particularly more recently, its preventive efficacy has b een questioned. The aim of this study therefore was to analyze the role of ureteral stent placement in the prevention of Steinstrasse. Methods: We analyzed data of 1087 patients who had been treated with a Wolf Piezolith 2300 in the General Infirmary in Leeds/UK for stones ranging fro m 10 to 95 mm in diameter. Results: The incidence of Steinstrasse was 6.3%. The likelihood was signifi cantly correlated with the stone size and was significantly less in patient s with stones >20 mm if a stent had been inserted prior to SWL, Moreover, i n these patients, the risk of acute clinical symptoms in the event of Stein strasse was greatly reduced, and the treatment could be continued safely in the majority of cases (86%), Treatments of the Steinstrasse itself with SW L resulted in its clearance in most of the cases (78%). It was always possi ble to clear even extended persistent Steinstrasse by laser lithotripsy. Conclusion: These results provide a clear indication for the pre-SWL insert ion of a ureteral stent in patients with stones >20 mm in diameter. In the event of Steinstrasse, SWL of the collection should be tried before more in vasive endourologic procedures are considered.