COMPARISON OF STENTED VERSUS NON-STENTED PATIENTS OF URETERIC CALCULI AFTER INTRACORPOREAL LITHOTRIPSY

Abstract

Background: Urolithiasis is a prevalent urological condition resulting from crystalline deposits in the urinary tract, often manifesting as acute flank pain and lower urinary tract symptoms. Ureteral stents, commonly placed after ureteroscopic lithotripsy to ensure patency and prevent complications, may themselves cause discomfort, hematuria, and infection. Given this clinical dilemma, evaluating the necessity of routine stent placement is vital to improve postoperative recovery and patient quality of life.

Objective: To compare the postoperative outcomes in terms of pain and hematuria between stented and non-stented patients undergoing ureteroscopic intracorporeal lithotripsy for ureteric calculi.

Methods: This randomized controlled trial was conducted at the Department of Urology, Institute of Kidney Diseases, Peshawar, from August 2024 to January 2025. A total of 170 patients aged 18–65 years with confirmed unilateral ureteric calculi were enrolled and randomized into two groups. Group A (n=85) received a 6 Fr double J ureteral stent post-procedure, while Group B (n=85) did not. All patients underwent ureteroscopic intracorporeal lithotripsy using a 6 Fr ureteroscope and pneumatic lithotripter under general anesthesia. Pain was assessed using the Visual Analog Scale (VAS), and hematuria was defined as ≥3 red blood cells per high-power field in centrifuged urine. Statistical analysis was performed using SPSS v23, with p-values ≤0.05 considered significant.

Results: The mean VAS pain score in the non-stented group was significantly lower (3.2 ± 1.7) compared to the stented group (5.8 ± 2.1), p<0.001. Mild pain was reported in 61.2% of non-stented patients versus 22.4% in stented patients, while severe pain occurred in only 4.7% of non-stented compared to 34.1% of stented patients. Hematuria was present in 28.2% of the non-stented group versus 50.6% of the stented group (p=0.002).

Conclusion: Routine ureteral stenting following uncomplicated ureteroscopic lithotripsy significantly increases postoperative discomfort and hematuria. A selective, risk-based stent placement strategy may offer safer, more comfortable recovery and optimized resource utilization.