A treatment strategy to help select patients who may not need secondary intervention to remove symptomatic ureteral stones after previous stenting.

Stojkova Gafner, Elena; Grüter, Thomas; Furrer, Marc A.; Bosshard, Piet; Kiss, Bernhard; Vartolomei, Mihai D; Roth, Beat (2020). A treatment strategy to help select patients who may not need secondary intervention to remove symptomatic ureteral stones after previous stenting. (In Press). World journal of urology Springer-Verlag 10.1007/s00345-020-03087-1

[img] Text
Fu_A treatment strategy to help select patients who may not need secondary intervention to remove symptomatic ureteral stones after previous stentin_270220.pdf
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (499kB) | Request a copy

PURPOSE This study aimed at evaluating whether removal of the ureteral stent the day before scheduled secondary intervention facilitates spontaneous ureteral stone passage and thus can spare the pre-stented patient this surgery. METHODS Retrospective analysis of a single-centre consecutive series of 216 patients after previous stenting due to a symptomatic ureteral stone from 01/2013 to 01/2018. Indwelling stents were removed under local anaesthesia. Patients were told to filter their urine overnight. Multivariate analysis was performed to assess predictive factors for spontaneous stone passage. RESULTS 34% (74/216) of patients had spontaneous stone passage while the stent was indwelling. Of the remaining 142 patients, 41% (58/142) had spontaneous stone passage within 24 h after stent removal. Only 84/216 (39%) patients needed secondary intervention. Multivariate logistic regression analysis of all 216 patients showed a significant association between spontaneous stone passage and smaller stone size (p < 0.001), distal stone location (p = 0.046) and stent dwell time (p = 0.02). Predictive factors for spontaneous stone passage after stent removal were smaller size (p < 0.001), distal location (p = 0.001), and stone movement while the stent was indwelling (p = 0.016). A treatment strategy was established that helps select patients suitable for conservative management. CONCLUSIONS The majority (61%) of ureteral stones passed spontaneously after pre-stenting; 34% while the stent was indwelling, 27% within 24 h after stent removal. Besides distal stone location, stone size (< 6 mm) and stone movement (≥ 5 cm) while the stent is indwelling indicate patients who are likely to pass their ureteral stone spontaneously after stent removal. The treatment strategy (decision tree) presented here helps identify those patients. TRIAL REGISTRATION https://doi.org/10.1186/ISRCTN12112914.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Urology

UniBE Contributor:

Stojkova Gafner, Elena; Furrer, Marc; Bosshard, Piet; Kiss, Bernhard and Roth, Beat

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0724-4983

Publisher:

Springer-Verlag

Language:

English

Submitter:

Jeannine Wiemann

Date Deposited:

16 Mar 2020 13:18

Last Modified:

16 Mar 2020 13:18

Publisher DOI:

10.1007/s00345-020-03087-1

PubMed ID:

31960109

Uncontrolled Keywords:

Double J Pre-stenting Spontaneous stone passage Ureteral stone Urolithiasis

BORIS DOI:

10.7892/boris.141108

URI:

https://boris.unibe.ch/id/eprint/141108

Actions (login required)

Edit item Edit item
Provide Feedback