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EAU 2018: The Diameter Of The Ureteral Stent Has An Impact On Pain Levels And Quality Of Life During Short Term Treatment

Copenhagen, Denmark (UroToday.com) The use of ureteral stents in stone therapy is common, but with trade-offs in patient quality of life, discomfort, and pain. However, attempts to reduce side effects of discomfort via the optimization of form material and positioning of ureteral stents have failed to show significant improvements in prospective cohort studies. Stent size has been suggested to be significantly associated with patient quality of life.

Dr. Witte (MD) of Hochtaunusklinken Bad Homburg Department of Urology presents a prospective, randomized control trial of 315 patients undergoing ureterorenoscopy (URS) via stent Fr 4.7 (arm 1), Fr 6 (arm 2), and Fr 7 (arm 3). Validated questionnaires assessing pain, quality of life, and rate of urinary tract infections were collected for a five week follow-up period, with primary outcomes of pain and discomfort and secondary outcome of treatment success or failure.

After exclusion, 181/ 315 patients remained in final analysis (48 patients in arm 1, 66 in arm 2, and 67 in arm 3), of which there were no statistically significant differences in age and gender between the three arms. Pairwise comparisons between the three arms showed no significant differences between arm 2 versus arm 3, but did show significantly higher quality of life and lower discomfort / pain symptoms in arm 1 patients.

Dr. Witte notes that, due to the small sample size, multivariable regression models were not generated to compare efficacy of treatment or to establish non-inferiority between the three stent sizes. Furthermore, two stents dislocated in arm 1 and one stent dislocated in arm 3, but these rates could not be confirmed to be superior / non-inferior due to the small sample size.

In conclusion, the study shows a significant benefit in regards to pain levels and quality of life for patients with smaller stents during URS. Additionally, the use of smaller stents does not compromise the success of URS and does not contribute to stent dislocation. Future studies to validate these findings and to establish non-inferiority/ superiority are encouraged, but the Fr 4.7 stent is a comparable alternative to be considered for the short-term treatment of ureteral stones.

Authors: Nestler S., Witte B., Schilchegger L., Jones J.

Written by: Linda M. Huynh, B.S., University of California-Irvine, at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark