STENT


Survey on ureTEric draiNage post uncomplicaTed ureteroscopy (STENT)

Published in BJUI 2020

STENT

Background

The National Institute for Health and Care Excellence (NICE) and the European Association of Urology (EAU) guidelines encourage clinicians notto leave stents after uncomplicated ureteroscopies. Ureteric drainage practice internationally is variable. The published evidence alludes towards a high tendency of temporary ureteric stenting even after uncomplicated ureteroscopy (Hughes et al, 2014)(Auge et al, 2007). A recent Cochrane review on ureteral stenting after uncomplicated ureteroscopy reported desirable and undesirable effects of stents were small in absolute terms. All included studies had limitations. The Cochranereview identified a need to conduct higher quality sufficiently powered trials to answer this important question. (Ordonez M, 2019).

 

Aims and Objectives

Primary objective:

1. To assess the uncertainties about the feasibility of an interventional study assessing whether not stenting after uncomplicated ureteroscopy is superior to routine ureteric drainage (e.g. JJ stent or equivalent).
Secondary aims:
1. To understand current views and practice about ureteral stenting after uncomplicated ureteroscopy.

References

NICE guideline [NG118] Published date: January 2019. https://www.nice.org.uk/guidance/ng118. Accessed 22-05-19.

Türk C,Knoll T,Petrik A,Sarica K,Seitz C,Straub M. EAU Guidelines on Urolithiasis. Uroweb 2012. Available at: https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Urolithiasis-2018-large-text.pdf. Accessed 22 May 2019

Auge, Brian K, Jamey A Sarvis, James O L’esperance, and Glenn M Preminger. 2007. “Practice Patterns of Ureteral Stenting after Routine Ureteroscopic Stone Surgery: A Survey of Practicing Urologists. Journal of Endourology 21(11): 1287–91.

Hughes, Ben et al. 2014. “The Dilemma of Post-Ureteroscopy Stenting.” BJU international 113(2): 184–85.

Ordonez M, Hwang EC, Borofsky M, Bakker CJ, Gandhi S, Dahm P. Ureteral stent versus no ureteral stent for ureteroscopy in the management of renal and ureteral calculi. Cochrane Database Syst Rev [Internet]. 2019;(2).

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Follow-on project:

PERSIST: Perceptions, experiences and reflections of urologists on Stent Insertion after Stone Treatment

 

Project

This was a project conducted with the CHART CTU in Aberdeen following an award at BAUS dragons den prize (supported by BAUS and TUF).

Aim

To understand the reasons why urologists unnecessarily insert stents after uncomplicated stone treatment in the UK and to design an intervention to ensure stents are used appropriately

Input and endorsements

PERSIST has been designed in close consultation with our Patient and Public Involvement (PPI) group, with consensus reached on outcome measures. PERSIST has also been recognized by GIRFT (Getting It Right First Time) as an important subject area that can inform and improve the delivery pathway for acute urinary tract stone management.

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