Sfoungaristos S et al, 2011: Stenting or not prior to extracorporeal shockwave lithotripsy for ureteral stones? Results of a prospective randomized study
Sfoungaristos S, Polimeros N, Kavouras A, Perimenis P
Urology Department, Patras University Hospital, Building A, 4th floor, Rion, 26500, Patras, Greece
PURPOSE: To determine the need for pre-treatment stenting in patients undergoing extracorporeal shockwave lithotripsy (ESWL) for ureteral stones sized 4-10 mm.
METHODS: A prospective randomized study was conducted between September 2009 and March 2011. Included 156 patients randomized in stented and non-stented groups and underwent a maximum of 3 ESWL sessions. Radiographic follow-up was used to assess the stone fragmentation and clearance. Results were compared in terms of stone-free rates, post-treatment morbidity and complications.
RESULTS: Overall efficacy was 76.9%. Stone-free rates were statistically significantly lower (P = 0.026) in the stented group (68.6%) compared to the non-stented ones (83.7%). Furthermore, stenting was significantly correlated with post-treatment lower urinary tract symptoms (P ≤ 0.001), need for more ESWL sessions (P = 0.019) and possibility for operation due to ESWL failure (P = 0.026). A multivariate analysis was conducted to identify the parameters which may predict complete stone removal after ESWL. Stone size (P = 0.026), stone location (P = 0.011) and stenting (P = 0.007) were the most significant factors.
CONCLUSIONS: ESWL is an efficient and safe treatment for 4- to 10-mm ureteral stones. Pre-treatment stenting is limiting stone-free rates and is significantly influencing post-ESWL morbidity and quality of life in a negative manner, while it contributes minimally to the prophylaxis of complications.
Int Urol Nephrol. 2012 Jun;44(3):731-7. doi: 10.1007/s11255-011-0062-3. Epub 2011 Sep 30
PMID: 21960371 [PubMed - as supplied by publisher]
This is an interesting report of a prospective randomized comparison of results of ESWL-treatments for ureteral stones carried out with or without an internal stent. The stone-free rate was significantly better in the non-stented patients (83.7%) than in the stented (68.6%). Moreover, the patients with a stent required a greater number of ESWL sessions and had significantly more lower urinary tract symptoms.
These findings support the observation by others and are in accordance with my own clinical experience. For patients with ureteral stones who have had an internal stent inserted as an emergency procedure it might thus be of value –for selected patients- to consider stent removal in association with the ESWL-treatment.