Impact of Expedited Ureteroscopy on Emergency Department Utilisation in Stented Patients with Urolithiasis

Background/Objectives: Ureteric stents are commonly used in the management of urolithiasis but are associated with significant morbidity, leading to unplanned emergency department presentations and increased healthcare utilisation. This study aimed to evaluate whether reducing ureteric stent dwell time from three months to one month was associated with reduced stent-related emergency presentations. Secondary objectives were to assess post-ureteroscopy infective complications and identify predictors of emergency attendance. Methods: A retrospective cohort study was conducted across Western Sydney Local Health District, comparing patients undergoing ureteric stenting prior to ureteroscopy before (n = 189) and after (n = 244) an institutional policy change reducing time to definitive surgery from three months to one month. Patients aged ≥16 years with urolithiasis were included. Results: Following the policy change, mean waiting time for ureteroscopy decreased from 97.3 to 40.6 days. The proportion of patients presenting to the emergency department (ED) for stent-related symptoms decreased from 31.7% to 16.4% (p < 0.001), and mean presentations per patient declined from 0.60 to 0.21 (p < 0.001). Stent irritation accounted for most presentations. Using multivariable analysis, age < 50 years, immunosuppression, and positive pre-operative urine cultures were independently associated with ED attendance. Post-ureteroscopy infective complications were lower in the shortened dwell-time cohort (2.0% vs. 4.2%) but did not reach statistical significance (p = 0.26). Conclusions: Reducing routine ureteric stent dwell time from three months to one month was associated with significantly fewer stent-related emergency presentations. Shorter dwell protocols may reduce patient morbidity and healthcare utilisation and could be associated with lower rates of post-ureteroscopy infective complications.