REMOVING ureteral stents within 24–48 hours after ureteroscopy (URS) and holmium laser lithotripsy may significantly reduce patient morbidity while improving recovery and satisfaction, according to findings from a prospective comparative study.
Researchers evaluated 180 patients undergoing URS for unilateral ureteric or renal stones measuring 1–1.5 cm at a single academic centre between January 2021 and December 2024. All procedures were performed by the same surgeon, with patients receiving identical 6Fr × 26 cm double-J stents before being allocated to one of three removal schedules: 24–48 hours, 3–5 days, or 7–14 days after surgery.
Shorter Stent Duration Lowers Symptom Burden
The primary outcome was the Ureteral Stent Symptom Questionnaire (USSQ) total score. Patients whose stents were removed within 24–48 hours reported the lowest symptom burden, with a mean USSQ score of 68.4 compared with 76.8 in the 3–5-day group and 89.7 in the 7–14-day group (p<0.001).
Early removal was also associated with lower pain scores at Day 7, measured using the Visual Analog Scale (2.1 versus 3.9 and 4.8; p<0.001), and substantially lower opioid use. Patients in the earliest removal group required an average of 2.3 opioid tablets, compared with 5.6 and 8.4 tablets in the intermediate and longest-duration groups, respectively (p<0.001).
Faster Recovery Without Added Risk
Recovery was also quicker among patients whose stents were removed within 48 hours. They returned to normal activities in a mean of 3.2 days, compared with 5.9 days for those undergoing removal at 3–5 days and 8.7 days for those with stents left in place for 7–14 days (p<0.001). Patient satisfaction was highest in the early-removal group, with a mean score of 8.9 out of 10.
Importantly, complication rates did not differ significantly between the three groups, suggesting earlier removal did not compromise safety in appropriately selected patients.
Randomised Trials Needed
Multivariable analysis identified longer stent duration as the strongest independent predictor of worse stent-related symptoms, followed by female sex and age under 50 years.
The authors conclude that removing ureteral stents within 24–48 hours may offer meaningful benefits for selected patients by reducing symptoms, minimising analgesic requirements, and accelerating recovery without increasing complications. They suggest that removal after 3–5 days may be a practical alternative when earlier removal is not feasible, while noting that adequately powered randomised controlled trials are needed to confirm these findings.
Reference
Shwani MAR et al. Optimal timing for ureteral stent removal after ureteroscopy to minimize morbidity: a single-center prospective comparative study. Adv Urol. 2026;DOI: 10.1155/aiu/5753359D.
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