Tasian GE. et al., 2023: Ureteral Stent Placement Prior to Definitive Stone Treatment is Associated with Higher Post-Operative Emergency Department Visits and Opioid Prescriptions for Youth Having Ureteroscopy or Shockwave Lithotripsy.
Tasian GE, Maltenfort MG, Rove K, Ching CB, Ramachandra P, DeFoor B, Fernandez N, Forrest CB, Ellison JS.
Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Surgery, Division of Urology, Children's Hospital Colorado, Aurora, Colorado.
Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, Ohio.
Department of Surgery, Division of Urology, Nemours Children's Health, Wilmington, Delaware.
Department of Surgery, Division of Urology, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio.
Department of Surgery, Division of Urology, Seattle Children's Hospital, Seattle, Washington.
Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Urology, Children's Wisconsin & Medical College of Wisconsin, Milwaukee, Wisconsin.
Background: Little is known about the impact of ureteral stents on youth having stone surgery. We evaluated the association of ureteral stent placement before or concurrent with ureteroscopy (URS) and shockwave lithotripsy (SWL) with emergency department (ED) visits and opioid prescriptions among pediatric patients.
Methods: We conducted a retrospective cohort study of individuals aged 0-24 years who underwent URS or SWL from 2009-2021 at 6 hospitals in PEDSnet, a research network that aggregates electronic health record data from children's health systems in the United States. The exposure, primary ureteral stent placement, was defined as a stent placed concurrent with or within 60 days before URS or SWL. Associations between primary stent placement and stone-related ED visits and opioid prescriptions within 120 days of the index procedure were evaluated with mixed-effects Poisson regression.
Results: Two-thousand ninety-three patients (60% female; median age 15 years, IQR 11-17) had 2,477 surgical episodes; 2,144 were URS and 333 were SWL. Primary stents were placed in 1,698 (79%) of URS episodes and 33 (10%) of SWL episodes. Ureteral stents were associated with a 33% higher rate of ED visits (IRR 1.33; 95% CI 1.02-1.73) and a 30% higher rate of opioid prescriptions (IRR 1.30; 95% CI 1.10-1.53). The magnitudes of both associations were greater for SWL. Results were similar for age <18 and were lost when restricted to concurrent stent placement.
Conclusions: Primary ureteral stent placement was associated with more frequent ED visits and opioid prescriptions, driven by pre-stenting. These results support elucidating situations where stents are not necessary for youth with nephrolithiasis.
J Urol. 2023 Feb 22:101097JU0000000000003389. doi: 10.1097/JU.0000000000003389. Online ahead of print. PMID: 36812398
The clinical problems associated with stenting before or concurrent with URS and SWL were studied in young patients. Data were received from a research network in USA. In this database it was possible to identify 2093 patients and there were 2144 URS-treatments and 333 SWL-treatments. The conclusion was that stenting resulted in 33% increased emergency department visits and 30% resulted in prescription of opioids. Interestingly, the problem was greater for patients treated with SWL, although as many as 79% of the stents were placed in association with URS and only 10% in patients treated with SWL.
The findings surprise me, particularly in terms of opioid consumption. Given the transport capacity of young persons’ ureters it seems recommendable to use stents only when considered unavoidable. But it is not possible to read out from the article whether stenting was overused or not.