Pre Stenting or not prior to URS/RIRS
Of late the surgical management of urinary stones have been dramatically changed because of various technological advances. At many centres in USA, RIRS is fast becoming the standard treatment for renal stone as against PCNL. PCNL appear to be restricted to Academic Centres of late and this is probably because at many centres even today the Radiologist performs the Initial access into the collecting system. At most centres Semi Rigid Ureteroscope is being replaced by Flexible scopes.
This raises the issue as to whether a pre stenting has to be performed when RIRS for Renal stones and URS for Ureteral Stones are attempted.
The recommendations of the European Association of Urology (EAU) and the American Urological Association (AUA) are quite divergent: The EAU guidelines state ‘pre-stenting facilitates URS and improves outcomes of URS (in particular for renal stones) – Strong Recommendation’ while the AUA guidelines state ‘placement of a ureteric stent prior to URS should not be performed routinely – Strong Recommendation’. Both are strong Recommendations.
What is the attitude of us Indian Urologists regarding this? A discussion on this would help us to clear the cobwebs surrounding this issue.
‘Should we Pre Stent the Ureter or Not prior to accepting a patient for these procedures’.
With warm regards,