Steinstrasse: a comparison of incidence with and without J stenting and the effect of J stenting on subsequent management

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Abstract
To analyse the effect of ureteric stenting on the incidence of steinstrasse and its effects on the subsequent management of steinstrasse. Four hundred adult patients with a unilateral stone burden (mean diameter 1.5–3.5 cm) were randomly allocated into two groups; in group 1, patients had a J stent inserted before extracorporeal shock wave lithotripsy (ESWL) and group 2 did not. Before randomization, the patients had normal renal function and no evidence of ureteric obstruction on intravenous urography. All patients underwent ESWL, with the shock waves delivered first to the most dependent part of the calculi. Patients who developed steinstrasse were identified and the effect of the size of the calculi and the presence of a J stent on the incidence and level of the steinstrasse, on the time of diagnosis, the size of the major stone fragment, associated presenting symptoms and effect on subsequent management were compared between the groups. Patients developed steinstrasse in both groups, with 12 (6%) and 26 (13%) in groups 1 and 2, respectively (significantly different, PPP<0.11). Similarly, J stenting had no effect on the subsequent treatment modalities to resolve steinstrasse. The use of J stenting before lithotripsy significantly lowers the incidence of steinstrasse in patients with a stone burden of 1.5–3.5 cm. The incidence of steinstrasse increases with the size of the calculi, whether or not a J stent is present; J stenting has no apparent effect on the mode of presentation or the subsequent management of steinstrasse.