Ureteral Stenting After Ureteroscopy for Stone Treatment, A Global Perspective on Indications and Outcomes
Condition: Stone;Renal; Stone, Kidney; Stone Ureter
MeSH terms: Kidney Calculi; Nephrolithiasis; Calculi
Study type: Observational [Patient Registry]

Summary: 
      Background: The exit strategy after ureteroscopy for stone treatment remains a topic for
      discussion. Current EAU guidelines on urolithiasis state that postoperative stenting is
      indicated in patients at increased risk of postoperative complications. Stenting is not
      considered necessary in all other cases, and after uncomplicated procedures.

      Objective: To analyse the postoperative ureteral stenting strategy in clinical practice
      looking at the indication, type of stents used and the duration of stenting after
      ureteroscopy for stone treatment. Furthermore, the investigators will examine in what setting
      the stents are being removed postoperatively.

      Study design: This study is a prospective, observational, international, multicentre registry
      study executed by uCARE.

      Study population: All patients >18 years with a ureter or renal stone who are planned for
      ureteroscopic treatment by semi-rigid and/or flexible ureteroscopy are eligible for this
      study.
    

Detailed description: 
      BACKGROUND AND RATIONALE

      The majority of patients with stones receive an indication for its active removal by
      ureteroscopy. In the last two decades, endourological treatment techniques have evolved with
      several technological advances through miniaturisation of ureteroscopes, digital
      improvements, and optical imaging enhancement techniques leading to a better image quality,
      and the development of different disposables such as single-use digital ureteroscopes. This
      advancement has led to an increased number of indications for ureteroscopic treatment. Aside
      from this, there are no specific contraindications for ureteroscopic treatment, apart from
      general problems such as being unfit for anaesthesia or the presence of urinary tract
      infections, according to the EAU guidelines.

      The indications for active stone removal of ureteral stones include persistent pain or
      obstruction, renal insufficiency, and in cases when spontaneous passage is less likely. The
      indications for active removal of renal stones include stone growth, stone formation in
      patients who are at high risk for stone formation, symptomatic patients, infection,
      obstruction, stones larger than 15 mm and the comorbidity profile, social situation and
      preference of the patient.

      The procedure can be performed using semi-rigid instruments, mainly for ureter stones, and/or
      by flexible ureteroscopes, for complete inspection and treatment of the upper tract.

      The exit strategy after stone treatment varies depending on patient characteristics and
      comorbidity, residual stone load, per-operative details and complications, and surgeons'
      preference. Stent placement is recommended by the EAU guidelines in case of increased
      postoperative complications; in cases of residual fragments, bleeding, perforation, pregnancy
      or urinary tract infections; as well as in all doubtful cases to avoid stressful emergencies.

      Postoperative stenting increases postoperative morbidity and urologists should carefully
      balance the pros and cons of postoperative stenting in each individual case. The ideal stent
      duration is not known. Ureteral stents are usually removed 1-day postoperatively and most
      urologists will remove double Js 1-2 weeks postoperatively.

      It remains a matter of debate whether to stent a patient postoperatively after a
      ureteroscopic procedure despite the EAU guidelines statement that routine stenting after an
      uncomplicated procedure with complete stone removal is not necessary.

      STUDY OBJECTIVES

      The aim of this registry is to review current clinical practice on postoperative ureteral
      stenting after ureteroscopy for stone treatment. The investigators will explore the answers
      to the following questions: What are the indications, predictors and outcomes for stent
      placement? What types of stents are used and what is the duration for stent placement? Hence,
      the investigators will assess in what setting the stents are being removed, looking at
      instrumentation, anaesthetics, and location.
    

Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        All patients >18 years old with a ureter or renal stone that are planned for ureteroscopic
        treatment are eligible for this registry.
      
Keywords: stone disease; ureteral stent; stenting; ureteroscopy treatment; stent placement; postoperative ureteral stenting; Société Internationale d'Urologie; uCARE