Dr. Ghani on the optimal duration of stenting following ureteroscopy

In this video, Khurshid R. Ghani, MD, highlights notable findings from the study, “What is the Optimal Stenting Duration after Ureteroscopy and Stone Intervention? Impact of Dwell Time on Post-operative Emergency Department Visits,” for which he served as the lead author. Ghani is a professor of urology at the University of Michigan in Ann Arbor, Michigan and the director of the Michigan Urological Surgery Improvement Collaborative (MUSIC).

Video Transcript:

So, we assessed just over 4000 patients undergoing ureteroscopy and stenting. All of these patients were not pre-stented. So, we excluded anyone who had surgery with a stent indwelling because we know from our prior work, that when you have a stent in your body, and then you have a surgery, the need to have a stent or the outcomes related to that are completely different. So, we excluded a lot of patients who had a stent indwelling.

We looked at everyone who had no stent, who underwent surgery, and then had a stent placed. And around 40% of those patients were stented with a string, with the sole reason that many providers will place strings, because it's easy for patients to remove that at home, it doesn't require an office visit, to have the stent removed in the clinic. And oftentimes, we'll tell patients, you can pull that stent on a string yourself in 2 days, in 3 days, in 4 days.

If I just look back in my own practice–I've been attending now for 10 years–in the early years of my practice, I used to tell patients to remove the stent in 2 days. I was like, "that's all you need. Two days, you'll be fine. And you pull it out." I actually found that patients were calling me afterwards in pain. They were pulling it out after 2 days, and they were in pain. So, that was an observation that I had personally. Over the last few years, there's 2 other data points that we as a group came across.

We found some work from the University of Iowa that showed that patients who had a string placed and they remove their stent in 3 days versus they removed a stent in 7 days, the patients who were stented, for a short duration, the 3 day group, had a higher rate of problems. They called the office with pain, which is exactly what I had noticed in my clinical practice, or they presented to the emergency room.

We also came across a study from South Korea; it was an animal study. They found that when you put a stent in the ureter, and you keep it in for a short duration, like a few days, versus 4 or 5 or 6 days, that the ureter is not optimally dilated. So you need to place a stent in the ureter and you need to wait for a little bit of time for the ureter to be maximally dilated.

So, we hypothesized as a result of some of the experience that we'd all seen in our own practice, some of the data that we've seen in some of these studies, that maybe if you had the stent in for a very short period, actually, that was not a good thing. That maybe that would actually lead to problems. So, that was the hypothesis. What we assessed in the MUSIC registry is all these patients, some had strings, some didn't have strings. And then we looked at the amount of time that the stent was in their body, when it was removed, and whether it was linked to an increase in post operative emergency room visits.

What we found is that when you had a short duration of stenting, so 1 day, 2 days, or 3 days, there was an increase in emergency room visits. But if you were stented for 4 days or more, and 5 days was optimal, you hadn't had an increase in visits. So as a result of this work, we came to the conclusion that maybe if you are going to stent someone, you should try and keep the stent time at a minimum of 4 or 5 days.

This transcription has been edited for clarity.