Ureteral stenting practices following routine ureteroscopy: an international survey

  • Jorge F. PereiraEmail author
  • Paul Bower
  • Eric Jung
  • Egor Parkhomenko
  • Timothy Tran
  • Simone Thavaseelan
  • Gyan Pareek
Original Article



Stent omission after routine ureteroscopy (rtURS) is accepted by current guidelines and may result in decreased patient morbidity and treatment costs. In a value-based healthcare model, the added morbidity and cost of routine stent placement may be scrutinized. Furthermore, data are limited on urologist cost knowledge and it is effect on ureteral stent placement. As such, we seek to describe ureteral stenting practices and urologist cost knowledge amongst US and non-US-based urologists.


The ureteroscopic practice patterns and cost awareness of members of the Endourological Society were surveyed using an international email listserv. Respondents were grouped by practice location (US vs non-US). Logistic regression was used to evaluate the associations of surgeon practice location with stenting practices.


233 completed responses were received with a response rate of 13.5%. Results revealed that 55% and 71% of respondents reported ureteral stent insertion after rtURS more than 75% of the time for ureteral and renal stones, respectively. Reporting stent insertion following more than 75% of rtURS was more common among US participants for both ureteral and renal stones. Overall, reported cost knowledge was high, but lower among US participants. On multivariable analysis, US respondents were more likely to place ureteral stents after rtURS for ureteral stones more than 75% of the time when compared to those abroad (OR 3.43 p < 0.01).


Ureteral stenting after rtURS is over utilized in the US compared to other countries. While this phenomenon is multifactorial in nature, cost knowledge may be under recognized as a determinant of ureteral stent placement following rtURS.


Ureteroscopy Ureteral stent Cost Practice patterns 



Cost knowledge score


Frequent stent placement


Interquartile range


Odds ratio




United States



  1. 1.
    Keeley FX Jr, Timoney AG (2007) Routine stenting after ureteroscopy: think again. Eur Urol 52(3):642–644 (epub 2007/02/06) CrossRefGoogle Scholar
  2. 2.
    Oberlin DT, Flum AS, Bachrach L, Matulewicz RS, Flury SC (2015) Contemporary surgical trends in the management of upper tract calculi. J Urol 193(3):880–884 (epub 2014/09/16) CrossRefGoogle Scholar
  3. 3.
    Pengfei S, Yutao L, Jie Y et al (2011) The results of ureteral stenting after ureteroscopic lithotripsy for ureteral calculi: a systematic review and meta-analysis. J Urol. 186(5):1904–1909 (epub 2011/09/29) CrossRefGoogle Scholar
  4. 4.
    Harmon WJ, Sershon PD, Blute ML, Patterson DE, Segura JW (1997) Ureteroscopy: current practice and long-term complications. J Urol 157(1):28–32 (epub 1997/01/01) CrossRefGoogle Scholar
  5. 5.
    Bader MJ, Eisner B, Porpiglia F, Preminger GM, Tiselius HG (2012) Contemporary management of ureteral stones. Eur Urol 61(4):764–772 (epub 2012/01/24) CrossRefGoogle Scholar
  6. 6.
    Joshi HB, Stainthorpe A, MacDonagh RP, Keeley FX Jr, Timoney AG, Barry MJ (2003) Indwelling ureteral stents: evaluation of symptoms, quality of life and utility. J Urol. 169(3):1065–1069 (discussion 9; epub 2003/02/11) CrossRefGoogle Scholar
  7. 7.
    Sighinolfi MC, Micali S, De Stefani S et al (2007) Indwelling ureteral stents and sexual health: a prospective, multivariate analysis. J Urol. 178(1):229–231 (epub 2007/05/15) CrossRefGoogle Scholar
  8. 8.
    Nabi G, Cook J, N’Dow J, McClinton S (2007) Outcomes of stenting after uncomplicated ureteroscopy: systematic review and meta-analysis. BMJ. 334(7593):572CrossRefGoogle Scholar
  9. 9.
    Denstedt JD, Wollin TA, Sofer M, Nott L, Weir M, Honey RJ (2001) A prospective randomized controlled trial comparing nonstented versus stented ureteroscopic lithotripsy. J Urol. 165(5):1419–1422 (epub 2001/05/09) CrossRefGoogle Scholar
  10. 10.
    Borboroglu PG, Amling CL, Schenkman NS et al (2001) Ureteral stenting after ureteroscopy for distal ureteral calculi: a multi-institutional prospective randomized controlled study assessing pain, outcomes and complications. J Urol. 166(5):1651–1657 (epub 2001/10/05) CrossRefGoogle Scholar
  11. 11.
    Cheung MC, Lee F, Leung YL, Wong BB, Tam PC (2003) A prospective randomized controlled trial on ureteral stenting after ureteroscopic holmium laser lithotripsy. J Urol. 169(4):1257–1260 (epub 2003/03/12) CrossRefGoogle Scholar
  12. 12.
    Ibrahim HM, Al-Kandari AM, Shaaban HS, Elshebini YH, Shokeir AA (2008) Role of ureteral stenting after uncomplicated ureteroscopy for distal ureteral stones: a randomized, controlled trial. J Urol. 180(3):961–965 (epub 2008/07/22) CrossRefGoogle Scholar
  13. 13.
    Assimos D, Krambeck A, Miller NL et al (2016) Surgical management of stones: American Urological Association/Endourological Society Guideline. PART I. J Urol. 196(4):1153–1160CrossRefGoogle Scholar
  14. 14.
    Auge BK, Sarvis JA, L’Esperance JO, Preminger GM (2007) Practice patterns of ureteral stenting after routine ureteroscopic stone surgery: a survey of practicing urologists. J Endourol 21(11):1287–1291CrossRefGoogle Scholar
  15. 15.
    Muslumanoglu AY, Fuglsig S, Frattini A et al (2017) Risks and benefits of postoperative double-j stent placement after ureteroscopy: results from the clinical research office of endourological society ureteroscopy global study. J Endourol. 31(5):446–451 (epub 2017/03/16) CrossRefGoogle Scholar
  16. 16.
    Byrne RR, Auge BK, Kourambas J, Munver R, Delvecchio F, Preminger GM (2002) Routine ureteral stenting is not necessary after ureteroscopy and ureteropyeloscopy: a randomized trial. J Endourol. 16(1):9–13 (epub 2002/03/14. eng) CrossRefGoogle Scholar
  17. 17.
    Rapoport D, Perks AE, Teichman JM (2007) Ureteral access sheath use and stenting in ureteroscopy: effect on unplanned emergency room visits and cost. J Endourol 21(9):993–997CrossRefGoogle Scholar
  18. 18.
    Seklehner S, Sievert KD, Lee R, Engelhardt PF, Riedl C, Kunit T (2017) A cost analysis of stenting in uncomplicated semirigid ureteroscopic stone removal. Int Urol Nephrol. 49(5):753–761 (epub 2017/02/16) CrossRefGoogle Scholar
  19. 19.
    Netto NR Jr, Ikonomidis J, Zillo C (2001) Routine ureteral stenting after ureteroscopy for ureteral lithiasis: is it really necessary? J Urol. 166(4):1252–1254 (epub 2001/09/08) CrossRefGoogle Scholar
  20. 20.
    Zygourakis CC, Valencia V, Moriates C et al (2017) Association between surgeon scorecard use and operating room costs. JAMA Surg. 152(3):284–291 (epub 2016/12/08) CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Columbia University Division of UrologyMount Sinai Medical CenterMiami BeachUSA
  2. 2.Warren Alpert Medical School of Brown UniversityProvidenceUSA
  3. 3.Division of UrologyRhode Island Hospital, The Miriam HospitalProvidenceUSA
  4. 4.Department of UrologyUniversity of CaliforniaIrvine, OrangeUSA
  5. 5.Minimally Invasive Urology Institute, The Miriam HospitalProvidenceUSA

Personalised recommendations