Outpatient ureteroscopic lithotripsy: Selective internal stenting and factors enhancing success

Purpose: To evaluate a policy of selective, short-duration internal stentin g after outpatient ureteroscopic laser lithotripsy. Patients and Methods: From January 1997 to April 1998, 62 patients (34 male , 28 female) with a mean age of 50 (range 21-80) years underwent outpatient ureteroscopic lithotripsy using a holmium laser (365 pm; 0.5-1.4J/5-10 Hz) and 6F/7.5F semirigid ureteroscope. Internal stents were inserted selectiv ely in patients with severe preoperative obstruction (intravenous urogram f inding), tight stone impaction (endoscopic finding), or significant residua l obstruction (on-table retrograde pyelogram finding) despite stone clearan ce. Patient demographics, stone measures, stone clearance rates, complicati ons, postoperative pain scores, analgesic requirement, and follow-up imagin g were compared for the stented and unstented patients. Results: With the present criteria of selective internal stenting, stents w ere inserted in 56% of the patients for a mean duration of 3.6 weeks. Exclu ding those patients with residual stones requiring further interventions, t he stenting rate was 39% with a mean duration of 1.9 weeks. There was no di fference in patient characteristics, stone burden, and stone levels between the stented and unstented group. The mean operating time for the unstented group was shorter than for the stented group (45.6 minutes nu 56.6 minutes ; P = 0.03). The stone clearance rates were similar for the two groups (96% nu 97%), but the complication rate of the stented group was higher (8.6% n u 3.7%). The mean postoperative pain score and analgesic requirement were s imilar in the two groups on postoperative day 1 but significantly less in t he unstented group on day 3. Conclusions: The criteria for selective internal stenting are useful in det ermining when a stent should be used. By omitting the stent insertion in th e absence of these criteria, operating time, postoperative pain, and analge sic requirement were reduced without increasing the complication rate. Uret eral structuring was absent despite the low stenting rate.