Abstract
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The uncertainty surrounding this topic is also confirmed by one of the major urologic guidelines, 1 where it is stated “prestenting facilitates ureteroscopic management” as well as “routine prestenting is not necessary.”
All that being said, this study confirms the common perception by the majority of urologists: prestenting assists following ureteroscopic manipulation, particularly in the case of renal stones.
However, caution has to be taken in interpreting these results.
First of all, like all the other articles on this topic, this is a purely retrospective study that guarantees only a low level of evidence.
Second, this article goes to extraordinary lengths to highlight only the advantages of this practice, neglecting the significant disadvantages such as additional anesthesia, hospitalizations, radiation exposure, and related costs, along with a potential increase of patient morbidity because of stent intolerance that can condition quality of life and work performances in as much as 80% of patients. 2 In addition, routine prestenting poses the problem of overoccupation of operating room schedules, especially in high-volume centers. Moreover, in this era of cost consciousness, economical implications related to this practice cannot be overlooked.
As such, can a benefit in terms of an increased stone free rate for 12% of patients and a decrease in complications for 8% of patients justify a routine prestenting in all other patients? Did the evidence provided by this article corroborate enough this concept to hypothesize this practice to be carried out before all ureteroscopy (URS)? Unfortunately, the quandary remains unsolved.
Only further well-designed, prospective, comparative, and possibly randomized studies will give us an exhaustive answer to this topic.
In the meantime, the decision to place a stent before URS, apart from when it is clinically required, will continue to be more likely influenced by personal habits rather than by an unequivocal scientific demonstration.