Surgeons in breach of guidelines on ureteral stents during lithotripsy

  • Khanna A & al.
  • Urology
  • 21 Jun 2019

  • International Clinical Digest
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Takeaway

  • Some surgeons continue to place ureteral stents in patients undergoing extracorporeal shockwave lithotripsy (ESWL), despite 2 decades of guidelines discouraging this practice.

Why this matters

  • A ureteral stent offers "no perceivable advantage" in reducing postoperative emergency department visits or reoperation after ESWL, say researchers.

Study design

  • Researchers analyzed treatment data from 4 states for patients who underwent ESWL either with or without ureteral stent placement (N=128,040).
  • Funding: None disclosed.

Key results

  • Surgeons performed stent placement during ESWL in 20,800 (16.2%) patients, most commonly in patients who:
    • Were older: OR, 1.003 per year (95% CI, 1.002-1.004).
    • Had higher comorbidity: OR, 1.10 (95% CI, 1.09-1.11).
    • Had higher incomes: OR, 1.13 (95% CI, 1.08-1.19).
    • Had private insurance: OR, 1.05 (95% CI, 1.008-1.10).
  • Patients who received stents were more likely to visit the emergency department within 30 days after ESWL (8.9% vs 7.3%; P<.0001 or to need reoperation within days of eswl vs p>

Limitations

  • The study was retrospective.
  • Specific reasons for stent placement were not available, nor were data on stone sizes, locations, or densities.