Ureteral Stenting During Extracorporeal Shock Wave Lithotripsy: Help or Hindrance?

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Abstract
We retrospectively reviewed the outcome of extracorporeal shock wave lithotripsy in patients with renal calculi less than 3 cm. in size who were treated at a large multi-user lithotripsy center. Patients in whom indwelling ureteral stents were placed before lithotripsy treatment were subjected to higher levels of total power (shocks times voltage), yet the rate free of stones did not differ from those treated without a stent. In addition, the patients with internal ureteral stents experienced a significantly higher incidence of urinary urgency (43 versus 25 percent) and hematuria (40 versus 23 percent) than nonstented patients, respectively (p < 0.05). Also, the duration of bladder discomfort was longer for stented patients (26 versus 13 percent) as was the duration of urinary frequency (31 versus 16 percent), compared to nonstented patients (p < 0.05). The results suggest that use of an indwelling ureteral stent may not contribute to a higher rate free of stones for the treatment of small to medium sized renal calculi and, in fact, it may make the treatment more uncomfortable for the patient than performing lithotripsy without ureteral stenting. Of course, in selected cases (solitary kidney, large stone burden and aid in stone localization) ureteral stenting has a useful adjunctive role in extracorporeal shock wave lithotripsy.