Clinical outcomes associated with double-J ureteral stents with extraction strings versus stents without extraction strings following uncomplicated ureteroscopic lithotripsy

Objectives: To compare postoperative clinical outcomes in patients with ureteric stents on extraction strings versus stents without extraction strings and associated variables following uncomplicated ureteroscopic lithotripsy. Patients and Methods: In this single center, observational study, patients who underwent stent placement after an uncomplicated ureteroscopic lithotripsy were reviewed. The population was characterized based on the method of stent extraction, and multivariable analyses were performed to explore relationships with clinical outcomes. Results: A total of 215 (52.6%) and 193 (47.3%) patients were included in the ureteric stents on extraction strings and stents without extraction strings groups, respectively. Sociodemographic characteristics were comparable between the groups. In the bivariate analysis, patients in the ureteric stents on extraction strings group exhibited a higher risk of urinary tract infections (risk ratio = 1.41; 95% confidence interval = 1.11–1.79; p = 0.024), but a lower risk of emergency room visits due to pain (risk ratio = 0.06; 95% confidence interval = 0.02–0.18; p < 0.001). However, these associations did not remain statistically significant in the multivariable analysis. In the multivariable analysis, statistically significant associations with overall complications were observed for residence in rural areas (risk ratio = 0.51; 95% confidence interval = 0.28–0.95) and the use of ureteral stents with extraction strings (risk ratio = 0.53; 95% confidence interval = 0.29–0.94). Ureteric stents on extraction strings was not associated with an increased risk of overall complications (risk ratio = 0.42; 95% confidence interval = 0.20–0.85; p = 0.016). No association was found between the stent extraction method and reoperation or early accidental stent removal. Conclusions: Ureteric stents on extraction strings is associated with lower complication rates and shorter hospital stays. These findings provide valuable insights for urologists, supporting clinical decision-making based on the complication profiles of stents without extraction strings versus ureteric stents on extraction strings. Furthermore, this evidence serves as a strong foundation for future prospective studies aimed at comparing the safety and efficacy of both interventions. Level of evidence: 3a