Ureteral Stenting and Urinary Stone Management: A Systematic Review

Purpose

Ureteral stents are widely used in many urological procedures. We evaluated the recent literature, providing an update on materials and stent designs, and indications for stent placement and stent complications, including the management of such stent related problems.

Materials and Methods

A thorough literature search on ureteral stents was performed. Pertinent new and review/updated articles published in the English literature from 2000 through 2006 were systematically reviewed.

Results

Following uncomplicated ureteroscopy or shock wave lithotripsy routine stenting does not appear to affect the stone-free rate. However, stent related morbidity is often seen. Patients at greatest risk for complications are those undergoing bilateral stentless ureteroscopy, those with recent or recurrent urinary tract infections and pregnant patients. The placement of indwelling stents in these patients should be considered. The development of stent materials and designs has been directed toward decreasing stent related morbidity, such as pain, discomfort, bladder irritability, infection and encrustation. Changes in stent design and materials show great promise. Initial evaluations suggest improvements in patient comfort as well as decreased encrustation. Forgotten stents can lead to significant morbidity as a result of severe encrustation. Most cases can be managed endoscopically, often requiring multiple procedures.

Conclusions

Stenting is not mandatory after uncomplicated simple ureteroscopy and shock wave lithotripsy. Patients with stents seem to have significantly more bladder and lower urinary tract symptoms than those in whom stents are not placed. However, there is a subgroup of patients who likely benefit from stenting following a procedure because of the increased risk of complications. The ideal ureteral stent biomaterial has yet to be discovered and an area of promising development is the drug eluting stent to prevent infection and encrustation.

Key Words: ureter, stents, lithotripsy, complications, ureteroscopy

Abbreviations and Acronyms: EHL, electrohydraulic lithotripsy, PCN, percutaneous nephrostomy, SWL, shock wave lithotripsy