From the Guidelines
Urethral stent placement is not routinely recommended for uncomplicated ureteral stone removal, but it is indicated in cases of ureteral injury, stricture, solitary kidney, renal insufficiency, or large residual stone burden. The decision to place a urethral stent should be based on individual patient factors and the presence of complications. According to the 2007 guideline for the management of ureteral calculi 1, stenting following uncomplicated URS is optional, and several randomized prospective studies have demonstrated that routine stenting after uncomplicated URS may not be necessary.
Indications for Stenting
The indications for stenting after the completion of URS include:
- Ureteral injury
- Stricture
- Solitary kidney
- Renal insufficiency
- Large residual stone burden These conditions may require stenting to ensure proper urinary flow and prevent complications.
Complications of Stenting
Ureteral stenting is associated with several complications, including:
- Bothersome lower urinary tract symptoms
- Pain
- Stent migration
- Urinary tract infection
- Breakage
- Encrustation
- Obstruction These complications can alter the patient's quality of life and require additional medical interventions.
Recent Guidelines
The 2020 ACR Appropriateness Criteria for radiologic management of urinary tract obstruction 1 recommends considering cystoscopic retrograde ureteral decompression with double-J stents prior to definitive ureteroscopic stone extraction. This approach can help manage sepsis and acute ureteral obstruction effectively. However, the choice between retrograde ureteral stenting and percutaneous nephrostomy (PCN) depends on individual patient factors, such as the risk of anesthesia and the presence of pyonephrosis.
Patient Management
Patients undergoing urethral stent placement should be managed with prophylactic antibiotics, such as ciprofloxacin 500mg twice daily for 3-5 days, to prevent infection. Increasing fluid intake to 2-3 liters daily can help flush the urinary system and reduce the risk of complications. The effectiveness of urethral stents depends on their ability to maintain the patency of the urethral lumen, allowing for normal urinary flow while the underlying tissue heals or as a long-term solution for chronic strictures.
From the Research
Urethral Stent Placement
- Urethral stents are employed in the lower urinary tract for restitution or maintenance of urinary drainage 2.
- Placement of urethral stents is indicated as a last resort in patients with prostatic hyperplasia who no longer respond to medical treatment and who are not candidates for more invasive surgical treatment 2.
- Urethral stents can be used in the bulbar urethra to reduce restricture rates following endoscopic treatment of strictures 2.
Management of Restenosis after Urethral Stent Placement
- Restenosis after urethral stent placement can be managed with endoscopic and open surgical treatment 3.
- The overall success rate for treatment after stent failure was 67% for posterior urethral strictures and 82% for anterior strictures 3.
- Urethral stent failure requires complex intervention, and a failed posterior urethral stent can often be managed endoscopically, while a failed anterior urethral stent can be managed with urethroplasty 3.
Urethral Stricture Treatment
- Urethral stricture is defined by a decrease in the caliber of the urethral lumen, which can cause a decrease or an interruption of the urine flow 4.
- Treatment of urethral stricture ranges from conservative management to open surgery and requires specialized surgeons and an adequate technical platform 4.
- The evolution of surgical techniques has significantly increased long-term success rates, and the classical saying "once a stricture, always a stricture" is no longer the rule 4.
New Urethral Stent Technologies
- The UVENTA urethral stent is a temporary self-expandable covered metallic stent with an anti-migration system and different radial force distribution 5.
- The UVENTA stent showed a satisfying safety profile with few and low-grade complications, and an overall success rate of 73% in treating urethral strictures 5.
- The UroLume urethral stent has been associated with long-term complications, including urethral restenosis, urethral pain, recurrent urinary tract infections, and stent migration 6.
- Ultrasonography and magnetic resonance imaging can be used to diagnose and manage UroLume complications 6.