Stent omission after ureteroscopy is safe, improves patient-reported outcomes

Stent omission following ureteroscopy improves patient-reported outcomes compared with stent placement while not compromising patient safety, according to data presented at the 2025 American Urological Association Annual Meeting in Las Vegas, Nevada.¹

The findings were presented by Seth K. Bechis, MD, of the University of California, San Diego.

Seth K. Bechis, MD

“The AUA guidelines do suggest considering stent omission in select cases. Yet the reality is 83% of cases still go with stents placed; urologists are still commonly placing stents,” Bechis explained during the presentation. “Studies are limited, especially high-quality prospective studies looking at renal stones. Currently there are no prospective studies comparing stent vs no stent for treatment of renal stones via ureteroscopy.”

To that end, the investigators conducted a prospective trial where patients were randomly assigned to receive a stent or no stent following ureteroscopy. Notably, the randomization in the trial occurred intraoperatively––that is, the surgeon was blinded to the randomization until the end of the case.

Bechis also added, “Importantly, the operative decision-making was left up to the surgeon. They could choose the ureterscope, they could choose the laser type [and] technique, whether they used a ureteral access sheath, [the] irrigation method, and finally, the stent choice, if applicable.”

In total, the trial included 102 patients, of whom 26 were excluded due to an intraoperative complication. Of those remaining, 36 patients were randomly assigned to receive a stent, and 38 patients were randomly assigned to receive no stent. The 2 cohorts were balanced in terms of stone size and location, with the average stone size being 10 mm.

Data showed that stent omission shortened the case time by an average of 6.5 minutes. The results also showed that superficial mucosal lesions of the ureter were common following ureteroscopy.

On the primary outcome of 30-day complications, the investigators found no significant difference between the 2 arms. Specifically, an ER visit or hospitalization was required in 8.3% of patients in the stent placement cohort vs 10.5% of patients in the stent omission cohort (P = .748).

Additionally, patient-reported pain scores were significantly improved with stent omission.

Bechis noted, “In PROMIS, a 2-point difference has been shown to be clinically meaningful. In our data, we found that the scores improved by 7 or 8 points in the group that was had a stent omitted.”

Patients who did not receive a stent also showed higher WISQOL scores. There was a difference of 16 to 19 points between cohorts, with a score greater than 10 being indicative of a clinically meaningful difference.

There was no significant difference between the cohorts in regard to the ability to return to work (OR, 0.377; 95% CI, 0.089 to 1.592; P = .184), post-operative urinary tract infections (OR, 0.471; 95% CI, 0.081 to 2.748; P = .402), follow-up imaging abnormalities (OR, 1.00; 95% CI, 0.060 to 16.690; P = 1.000), or in patient-reported opiate medication use post-operatively (P = .711).

Additionally, the stone-free rate was comparable between both arms (P = .267). Specifically, a residual stone was reported in 33.3% of patients who received a stent vs 44.7% of patients who did not receive a stent.

Patients also generally preferred stent omission, according to survey data. When asked if they would undergo the same procedure for another stone, 44.7% of patients in the stent omission group responded “definitely”, compared with 22.2% of patients who had a stent placed (P = .209). Further, when asked if they would prefer the same treatment assignment, 52.6% of patients in the stent omission cohort responded, “definitely,” compared with 19.4% of patients who had a stent placed (P = .016).

Based on these findings, Bechis concluded, “I would urge all of you, when you're in practice, if you're performing a ureteroscopy for an uncomplicated case; if your stone burden is 1 to 1.5 cm or less; if your average stone size is a cm; if at the end of your case, you have fragments that are left over, but they're less than 1 mm; or perhaps you have dust or nothing at all, even if you use a ureteral access sheath, consider not leaving a stent, because your patients will have a better quality of life, and we found no detectable difference in unplanned encounters.”

REFERENCE

1. Bechis SK, Wollin DA, Rivera M, et al. Randomized multicenter trial of ureteral stent placement versus stent omission after ureteroscopy for renal stones. J Urol. 2025;213(5S2):e6. doi:10.1097/01.JU.0001111604.90306.91.11