Practice Patterns of Stent Omission After Ureteroscopy: Insights From a Statewide Collaborative Registry

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

Journal of Urology

Abstract

INTRODUCTION AND OBJECTIVE: Ureteral stent placement is the leading cause of postoperative morbidity after ureteroscopy (URS). Stent omission has been shown to be safe and result in less post-operative unanticipated healthcare utilization. While the American Urological Association (AUA) has provided a selective approach to stent omission after uncomplicated URS for stones < 1.5 cm, the adoption of this practice is largely unknown. We sought to evaluate practice patterns for stent omission in the state of Michigan using a statewide collaborative. METHODS: This is a retrospective cohort study of the Michigan Urological Surgery Improvement Collaborative (MUSIC) clinical registry involving patients who underwent ureteroscopy and laser lithotripsy of kidney stones between July 1, 2017, and June 30, 2024. Exclusion criteria included the use of stone basketing, anatomic abnormalities, bilateral procedures, and intraoperative complications. A multivariable logistic regression model was fit to calculate the predicted probability of stent omission for different stone sizes, adjusting for demographic and clinical characteristics. RESULTS: A total of 31,877 eligible ureteroscopy cases were identified from MUSIC. Since 2017, the overall stent omission rate amongst pre-stented patients increased from 28% to 42%. In contrast, amongst non-pre-stented patients, the stent omission rate has remained steady at 14-19%. The unadjusted stent omission rate by stone size for pre-stented patients was 40% for stones < 5 mm, decreasing to 18% for stones >1.5 cm. Conversely, in non-prestented patients, the stent-omission rate was 19% for stones < 5 mm, decreasing to 5% for stones >1.5 cm. Using the multivariable model, the predicted probability of stent omission decreased as stone size increased for both pre-stented and non-presented patients (p< 0.0001) even before the recommended cutoff of 1.5 cm (Figure 1). CONCLUSIONS: Stent omission for all patients decreases with stone size well before the recommended cutoff of 1.5 cm. These data suggest that despite recommendations from the AUA, Urologists use stone size, even at small sizes, to guide stent omission and have the most confidence in stent omission in pre-stented patients with small stones (< 5 mm). Future research should endeavor to evaluate the barriers to stent omission amongst Urologists.

Volume

213

Issue

5S

First Page

e668

Last Page

e668

Comments

American Urological Association Annual Meeting, April 26-29, 2025, Las Vegas, NV

DOI

10.1097/01.JU.0001109944.05171.19.13

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