Optimized tubeless strategy: combined pre-stenting and omission of postoperative ureteral stent reduces systemic inflammation and complications after flexible ureteroscopy for middle-upper calyceal stones

To evaluate the clinical and inflammatory outcomes of an optimized “pre-stented tubeless” strategy (preoperative stent placement followed by stent omission after surgery) compared to conventional stenting approaches in patients undergoing flexible ureteroscopy (FURS) for middle-upper calyceal stones. Patients were randomly divided into three groups: Group A (preoperative double-J stent placement for 2 weeks, followed by tubeless FURS without postoperative stenting), Group B (preoperative double-J stent placement for 2 weeks, followed by FURS with postoperative double-J stent retention), and Group C (no preoperative stenting, direct FURS with postoperative double-J stent placement).The inflammatory factors and clinical outcomes among the 3 groups are compared. There is a significant difference in operation time among the 3 groups, and group A has the shortest time ( P < 0.05). There have been no significant differences in stone clearance rate ( P > 0.05). Additionally, it is observed that the incidence of postoperative hematuria and bladder irritation in group A has been comparatively lower than those in groups B and C ( P < 0.01). At the same time, 24 h after the operation, among the 3 groups, the incidence of fever between groups A and B was considerably lower than that of group C ( P < 0.05). Lastly, CRP and WBC in groups A and B were lower than those in group C after the operation, and the difference was statistically significant ( P < 0.05). For patients with middle-upper calyceal stones, the combined strategy of preoperative stent placement and postoperative stent omission significantly reduces operative time and stent-related complications (hematuria, bladder irritation) without compromising stone clearance. Crucially, this strategy is associated with a significantly attenuated systemic inflammatory response (lower CRP and WBC) compared to primary FURS with postoperative stenting, demonstrating its feasibility and potential physiological benefits beyond current guideline recommendations. Randomized controlled trial MR-37-22-010550.