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

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Abstract

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.

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There was no direct or indirect commercial incentive associated with publishing the article.

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Authors and Affiliations

Authors

Contributions

ESG: data collection, manuscript writing, data analysis. TG: data collection, manuscript editing. MAF: data management, manuscript editing. PB: data analysis, manuscript editing. BK: manuscript editing. MDV: data analysis, manuscript editing. BR: project and protocol development, data management and collection, data analysis, manuscript writing and editing.

Corresponding author

Correspondence to Beat Roth.

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The authors declare that they have no conflict of interest.

Statement of human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was conducted in accordance with the “Strengthening the Reporting of Observational Studies in Epidemiology” (STROBE) statement and approved by the Ethics Committee of the Canton Bern, Switzerland (protocol number: KEK-Be 2017-01698).

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Informed consent was obtained from all individual participants included in the study.

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Stojkova Gafner, E., Grüter, T., Furrer, M.A. et al. A treatment strategy to help select patients who may not need secondary intervention to remove symptomatic ureteral stones after previous stenting. World J Urol 38, 2955–2961 (2020). https://doi.org/10.1007/s00345-020-03087-1

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  • DOI: https://doi.org/10.1007/s00345-020-03087-1

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