Ureteral Stent Placement After Ureteroscopy for Renal Stones: A Randomized Controlled Trial
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Kidney Calculi
- Sponsor
- Vanderbilt University Medical Center
- Enrollment
- 103
- Locations
- 7
- Primary Endpoint
- Total number of complications
- Status
- Completed
- Last Updated
- last year
Overview
Brief Summary
The rationale for this study is to determine if there is a difference in complications among patients undergoing ureteroscopy for renal stones who receive a stent compared to not receiving a stent postoperatively.
Detailed Description
Kidney stones affect 9% individuals within the United States, and the prevalence is increasing. Over the last few decades, ureteroscopy has become the most commonly performed stone procedure. However the complication rate after ureteroscopy is not insignificant. Reducing morbidity after ureteroscopy would improve patient outcomes and reduce health care utilization. A major contributor to patient morbidity after ureteroscopy is the ureteral stent, which is placed at the time of surgery and left in place 1-2 weeks after surgery. The rationale for utilizing stents is to prevent urinary obstruction from edema or stone fragments. On the other hand, stents cause hematuria, pain, and lower urinary tract symptoms. Additionally, stent-related symptoms are often misdiagnosed as urinary tract infections leading to unnecessary antibiotic use. The clinical utility of ureteral stents after ureteroscopy has not been well studied, specifically a stone located in the kidney. Prior studies on stent-less ureteroscopic procedures have focused on treatment of ureteral stones and not stones located in the kidney, have had restrictive inclusion and exclusion criteria, are primarily from single center institutions, and most being performed \~15 years ago. Surgical techniques and device innovations have changed the procedure since that time. To date, there have been only 2 studies that included stone located in the kidney showing no difference in unplanned hospital revisits, however both combined analyses with ureteral stones and selection bias was an issue for both studies. In addition, there is a lack of studies assessing opiate use, impact of quality of life with stent placement, and loss of work related to stent placement
Investigators
Ryan Hsi
Associate Professor
Vanderbilt University Medical Center
Eligibility Criteria
Inclusion Criteria
- •nonobstructing renal stone 1.5cm total stone diameter (if multiple stones, then sum of maximum diameters) or less undergoing ureteroscopy
Exclusion Criteria
- •age \< 18 years
- •pregnancy status
- •ureteral stone
- •preoperative hydronephrosis
- •indwelling nephrostomy tube
- •planning bilateral ureteroscopy or subsequent staged ureteroscopy
- •solitary kidney or eGFR \<60 mL/min (CKD stage 3 or greater)
- •variant anatomy including horseshoe kidney, pelvic kidney, prior urinary tract reconstruction
Outcomes
Primary Outcomes
Total number of complications
Time Frame: 30 days after ureteroscopy
Total number of complications - Defined as ER visits related to procedure, unanticipated provider visit, and hospitalization
Secondary Outcomes
- % return to work(5-10 days after ureteroscopy)
- WISQOL (Wisconsin Stone Quality of Life Questionnaire)(baseline to 5-10 days after ureteroscopy)
- Cumulative opiate morphine equivalent dosing (MED)(baseline to 5-10 days after ureteroscopy)
- PROMIS (Patient-Reported Outcomes Measurement Information System) form 6a(baseline to 5-10 days after ureteroscopy)
- Number of participants with abnormal imaging findings(4-8 weeks after ureteroscopy)
- Number of participants with symptomatic urinary tract infection (UTI)(Baseline 5-10 days after ureteroscopy)