Editorial Comment on: “Duration of Ureteral Stenting Following Ureteroscopic Perforation in a Porcine Model” by Reed et al.

This study “Duration of ureteral stenting following ureteroscopic perforation in a porcine model” is interesting considering the rise of ureteroscopy (URS) in recent times. ¹ The prevalence of stone disease and intervention for them have both increased for the past two decades. ^2,3 Although the rate of ureteral avulsion is between 0.04% and 0.9%, the rate of ureteral erosions and perforations vary between 0.13%–9.5% and 0.3%–7.4%, respectively. ⁴

The authors evaluate the timing of urothelial healing and duration of ureteral stenting after ureteral perforation in a porcine model, created through a 6.5 semirigid URS. Historically, the duration of ureteral stenting after ureteral injuries was 3–6 weeks. ⁵ In this two-part study, the authors initially look at the effect of 3, 7, 10, and 14 days of ureteral stenting in pigs with ureteral perforation. Although 3 days were not enough, 7 days or longer duration of stenting led to ureteral healing histologically with no extravasation or ureteral defects noted clinically. A subsequent 4-week short-term follow-up after stent removal showed no hydronephrosis, ureteral narrowing, or extravasation, and microscopically there was no fibrosis or scar with a patent normal ureteral lumen.

Given that functional ureteral healing occurs after 7 days, it is plausible that the stent duration after endopyelotomy or endoureterotomy could also be minimized. Stents are associated with significant symptoms and any reduction in their indwelling time would help improve patient's quality of life. ⁶ Similarly, shorter stent dwell time might allow the use of stent on strings that are removed early, avoiding the need for cystoscopy for their removal. ⁷

This is a landmark study that shows complete ureteral healing after full-thickness endoscopic ureteral perforation after 7 days of ureteral stenting with no short-term complications noted. The authors challenge the traditional dogma of stent duration after a ureteral injury. Although their results would need clinical confirmation in human studies, it will potentially change the concept of need and duration of post-URS stenting both with and without ureteral injuries. It is also likely to reduce the time interval needed for a second ureteroscopic procedure after initial ureteral perforation.