Comparative efficacy of pre-stented versus non-stented retrograde intrarenal surgery: A randomized controlled trial.

Background: Renal stone surgery has been significantly improved by various techniques, with retrograde intrarenal surgery (RIRS) gaining prominence. One potential approach to optimize RIRS outcomes is pre-stenting, where a ureteral stent is inserted before the procedure. Previous studies have explored its potential benefits, but the results are varied. This study aims to evaluate the outcomes of RIRS in patients who underwent pre-stenting versus those who did not, focusing on operative time, access sheath insertion success, stone-free rate, and postoperative complications such as urinary tract infections (UTIs).

Methods: A randomized controlled trial was conducted at the Department of Urology, Birat Medical College and Teaching Hospital, Nepal. A total of 126 patients undergoing RIRS were divided into 2 groups: pre-stented (n = 75) and non-stented (n = 51). Pre-stenting involved the placement of a ureteral stent before surgery, while the non-stented group did not receive this intervention. Key outcome measures included success rates for access sheath insertion, stone-free rate post-surgery, operative time, and postoperative complications, especially UTI. Statistical analysis was performed using SPSS-26, with a P-value of≤ .05 considered statistically significant.

Results: The pre-stented group showed a significantly shorter operative time (58.81 ± 16.21 min) compared to the non-stented group (68.65 ± 15.99 min; P = .001). Pre-stenting also resulted in a higher success rate for access sheath insertion (84.0% vs 58.8%, P = .002) and a higher stone-free rate (85.3% vs 64.7%, P = .007). In terms of intraoperative complications, the rates were similar between both groups (10.7% in pre-stented vs 13.7% in non-stented group, P = .603). The incidence of postoperative UTIs was slightly higher in the non-stented group (11.8% vs 5.3%, P = .190), though the difference was not statistically significant.

Conclusion: Pre-stenting prior to RIRS significantly enhances surgical outcomes, including improving access sheath insertion success, reducing operative time, and increasing the stone-free rate without a substantial increase in complications. These findings suggest that routine pre-stenting can be beneficial in patients undergoing RIRS for nephrolithiasis, leading to more efficient procedures and improved results.