APPROPRIATENESS CRITERIA FOR URETERAL STENT OMISSION FOLLOWING URETEROSCOPY FOR UROLITHIASIS: A SINGLE-CENTER EXPERIENCE

Background: Ureteral stenting following uncomplicated ureteroscopy (URS) and ureterorenoscopy remains a common practice. However, evidence suggests that routine stent placement may not be necessary in all cases. Dening clear criteria for uncomplicated URS could help establish when stent omission (SO) is appropriate. Objective: The primary objective of this study was to establish judicious and specic indications for stent omission following URS and ureterorenoscopy. The secondary objective was to evaluate the outcomes and complications associated with stent omission. Methods: This retrospective study reviewed all patients who underwent URS or ureterorenoscopy at the Urology Unit, Al-Khor Hospital, from 1 January 2017 to 31 December 2022. Adult patients (>18 years) were included. Exclusion criteria were renal anomalies, uncorrectable bleeding disorders, febrile urinary tract infection, solitary kidney, musculoskeletal deformities, and ureteral obstruction. Preoperative and intraoperative factors were recorded, including stone burden, preoperative stent presence, procedure time, and use of an access sheath. Postoperative events within 30 days were assessed, including unplanned ofce or emergency visits, admissions, or reoperations. Results: A total of 1,500 URSL procedures were reviewed. Of these, 636 (42.4%) cases were eligible for SO, and 360 (24.0% of total; 56.6% of eligible) underwent SO. Postoperative events occurred in 16.7% of SO cases (n=60) compared to 34.8% of stented cases (n=393, P = 0.03). Unplanned return visits occurred in 8.3% of SO cases (n=30) versus 17.4% of stented cases (n=199, P = 0.16). Thirty-day readmissions were 0% in the SO group compared to 6.5% (n=74) in the stented group (P = 0.08). The odds ratio for unplanned visits in the SO group was 0.43 (95% CI: 0.13–1.42, P = 0.17). No signicant associations were found between postoperative events and stone burden, procedure time, or preoperative stenting. Conclusion: Stent omission following uncomplicated URS is safe and associated with fewer postoperative events compared to routine stenting. These ndings support the development of appropriateness criteria to guide selective stent omission and reduce unnecessary morbidity.