Comparison Between Placement of Ureteric Stenting and Without Ureteric Stenting Following Uncomplicated Ureteroscopic Lithotripsy
Résumé fourni par la source
Background: Urinary stone disease is among the most prevalent urological disorders, and routine ureteric stenting after ureteroscopic lithotripsy remains contentious because its attendant morbidity may outweigh the presumed benefits in uncomplicated procedures. Objective: To compare postoperative morbidity and convalescence between ureteric stenting and stentless management following uncomplicated ureteroscopic lithotripsy for lower ureteric calculi in a resource-constrained tertiary setting. Methods: This quasi-experimental study enrolled 80 adults with lower ureteric stones undergoing uncomplicated pneumatic ureteroscopic lithotripsy at a tertiary hospital in Dhaka (August 2022–July 2023). Alternate assignment allocated participants to stenting (Group A, n=40) or no stenting (Group B, n=40). Flank pain and dysuria (visual analogue scale), urgency, frequency, suprapubic pain, haematuria and analgesia requirement were recorded at 24 hours, two weeks and four weeks and analysed in SPSS v26.0. Results: The groups were comparable in age (41±12.9 vs 40±13.1 years), male predominance (77.5% vs 82.5%), body-mass index (26.1±3.1 vs 26.5±3.1 kg/m²) and stone size (7.3±1.0 vs 7.2±1.1 mm; all p>0.05). Operative time was longer with stenting (29.4±8.4 vs 19.6±3.3 min; p<0.001). At every visit Group A reported higher flank-pain and dysuria scores (24-hour flank pain 4.2±0.6 vs 1.6±0.7; dysuria 5.0±0.8 vs 1.5±0.5; both p<0.001). Urgency (92.5% vs 17.5%), frequency (90% vs 17.5%), suprapubic pain (70% vs 7.5%), haematuria (60% vs 2.5%) and analgesia requirement (65% vs 15%) at 24 hours were all significantly greater with stenting (p<0.001). The stone-free rate was 100% in both groups. Conclusion: Omitting the ureteric stent after uncomplicated ureteroscopic lithotripsy shortens operative time and markedly reduces irritative urinary symptoms, pain and analgesia requirement without compromising stone clearance, supporting selective stentless management.