The effect of routine ureteral stent placement on post-ureteroscopy complications: A prospective study from a resource limited setting

Background: Rigid ureterorenoscopy (URS) stands as a highly successful treatment for ureteral stones. The current guidelines from the European Association of Urology (EAU) recommends selective double J (DJ) stent placement post-URS to mitigate major complications. However, in resource-limited hospital setups, executing selective stent placement poses substantial risks in preventing complications and reducing readmission rates. This study aims to unveil the ramifications of our routine stent replacement approach after ureteric stone surgery on surgical outcomes in a resource-constrained setting.Materials and Methods: This prospective study was conducted at a urological unit within a tertiary care center in Sri Lanka, over a one-year period, involving 112 diagnosed patients. Patients underwent routine DJ stenting following rigid URS for ureteral stone management, without additional intervention. Data collected from clinical records encompassed demographics, stone characteristics, and complications. Postoperative complications linked to routine DJ stenting were assessed using the Clavien-Dindo classification system. Descriptive statistics were employed for data summary using SPSS version 23.0.Results: The mean age of patients was 47.3±14.9 years (range: 13-76 years), with 67.9% being males. The mean stone size was 15.35±6.58 mm (range: 4.5-35 mm), distributed across right (48.2%), left (44.6%), and bilateral (7.1%) ureters, of which 52.7% were proximal, 30.4% distal, and 17% mid ureteric stones. Postoperative evaluation revealed 26.8% of patients experiencing Clavien-Dindo grade I complications (e.g.,dysuria, haematuria, loin pain, and lower urinary tract symptoms), managed conservatively. Moreover, 4.5% encountered Clavien-Dindo grade II complications, predominantly postoperative fever, necessitating hospital readmission specifically for intravenous antibiotic administration.Conclusion: Despite guidelines advocating selective stent placement, this study underscores the safety and efficacy of routine DJ stent implementation after the URS laser procedure. The findings showcase a notable reduction in postoperative complications alongside decreased hospital readmission rates in resourcelimited environments. Embracing routine DJ stenting post- URS in such settings could serve as a pragmatic approach, potentially enhancing patient outcomes and minimizing healthcare burdens.