Stent is a bane for urologists
摘要
To argue that routine ureteral stent placement after uncomplicated ureteroscopy constitutes an overused practice that imposes significant and often unnecessary morbidity on patients, and to advocate for selective, evidence-based stenting.
MethodsA narrative review of current literature was performed, examining evidence on stent-related symptoms, infectious complications, biofilm formation, forgotten stent sequelae, practice variation data, economic burden, and medicolegal consequences of routine ureteral stenting after ureteroscopy.
ResultsEvidence demonstrates that 78–80% of stented patients experience bothersome lower urinary tract symptoms, with over 80% reporting significant pain affecting daily activities. Stent biofilm formation occurs almost invariably within 1–2 weeks, and preoperative stent dwell time exceeding two months is associated with a nearly 4-fold increased risk of febrile urinary tract infection. Forgotten stents occur in up to 12% of cases and represent the single largest source of successful negligence claims in urology. Despite guideline recommendations, stenting rates persist at approximately 80%, with individual surgeon rates ranging from less than 10% to nearly 100%. The economic burden includes additional removal procedures, emergency department visits, and substantial patient productivity losses, with 58% of stented patients reporting reduced work capacity.
ConclusionRoutine ureteral stenting after uncomplicated ureteroscopy subjects the majority of patients to preventable morbidity with no consistent evidence of benefit. A paradigm shift toward selective, evidence-based stent placement is warranted. For appropriately selected low-risk patients, the safest stent is no stent at all.