Optimum duration of ureteral prestenting dwelling time in children undergoing retrograde intrarenal surgery


      Introduction and objectives

      Ureteral prestenting before retrograde intrarenal surgery (RIRS) causes passive dilatation of the ureter, improves stone-free rate and is associated with shorter operative time. However, the presence of a ureteric stent may increase the risk for septic complications, which accelerates with increased dwelling time duration. The aim of the present study is to explore the impact of ureteral prestenting timing in a group of children undergoing retrograde intrarenal surgery (RIRS) on perioperative outcomes and complication rates and to define the optimum duration of prestenting dwelling time.

      Patients and methods

      A retrospective study on 60 children aged less than 14 years, presented with upper tract urinary stones, who were subdivided into two groups: Group 1 and 2, each included 30 children who had undergone RIRS after ureteric stenting for two weeks and four weeks respectively. Success of ureteroscope introduction, operative time, stone free rate (SFR), intraoperative and postoperative complications and number of retreatment procedures after definitive RIRS were recorded and compared between the two treatment groups.


      Ureteric access was successfully obtained in all children in both groups. Patients in group 1 and 2 had a SFR of 86.6% and 90%, respectively (p = 0.199). The mean operative time of group 1 and 2 were 56.5 and 52.9 min (p = 0.612). Postoperative UTI rates increased with prolonged dwelling time from 6.7% in group 1 to 30% in group 2. No patient in both groups developed high grade complications.


      Figure 1
      Graphical AbstractFlow charts of children enrolled in the study.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cetti R.J.
        • Biers S.
        • Keoghane S.R.
        The difficult ureter: what is the incidence of pre-stenting?.
        Ann R Coll Surg Engl. 2011; 93: 31-33
        • Ji C.
        • Gan W.
        • Guo H.
        • Lian H.
        • Zhang S.
        • Yang R.
        • et al.
        A prospective trial on ureteral stenting combined with secondary ureteroscopy after an initial failed procedure.
        Urol Res. 2012 Oct; 40: 593-598
        • Ambani S.N.
        • Faerber G.J.
        • Roberts W.W.
        • Hollingsworth J.M.
        • Wolf Jr., J.S.
        Ureteral stents for impassable ureteroscopy.
        J Endourol. 2013 May; 27: 549-553
        • Al Busaidy S.S.
        • Kurukkal S.N.
        • Al Hooti Q.M.
        • Alsaraf M.S.
        • Al Mamari S.A.
        • Al Saeedi A.K.
        Is RIRS emerging as the preferred option for the management of 2–4 cm renal stones: our experience.
        Can J Urol. 2016; 23: 8364-8367
        • Ozkan K.U.
        • Bakan V.
        • Mil A.
        • Ozturk S.
        Ureteroscopic stone management in prepubertal children.
        Urol Int. 2010; 85: 320-323
        • Corcoran A.T.
        • Smaldone M.C.
        • Mally D.
        • Ost M.C.
        • Bellinger M.F.
        • Schneck F.X.
        • et al.
        When is prior ureteral stent placement necessary to access the upper urinary tract in prepubertal children?.
        J Urol. 2008 Oct; 180 (discussion 1863-4): 1861-1863
        • Sivalingam S.
        • Stormont I.M.
        • Nakada S.Y.
        Contemporary practice patterns in the management of acute obstructing ureteral stones.
        J Endurol Soc. 2015; 29: 736-740
        • Shields J.M.
        • Bird V.G.
        • Graves R.
        • Gomez-Marin O.
        Impact of preoperative ureteral stenting on outcome of ureteroscopic treatment for urinary lithiasis.
        J Urol. 2009; 182: 2768-2774
        • ElSheemy M.S.
        • Shoukry A.I.
        • Shouman A.M.
        • ElShenoufy A.
        • Aboulela W.
        • Daw K.
        • et al.
        Management of obstructive calcular anuria with acute renal failure in children less than 4 years in age: a protocol for initial urinary drainage in relation to planned definitive stone management.
        J Pediatr Urol. 2014; 10: 1126-1132
        • Assimos D.
        • Crisci A.
        • Culkin D.
        • Xue W.
        • Roelofs A.
        • Duvdevani M.
        • et al.
        Preoperative JJ stent placement in ureteric and renal stone treatment: results from the clinical research office of endourological society (CROES) ureteroscopy (URS) global study.
        BJU Int. 2016; 117: 648-654
        • Yang Y.
        • Tang Y.
        • Bai Y.
        • Wang X.
        • Feng D.
        • Han P.
        Preoperative double-J stent placement can improve the stone-free rate for patients undergoing ureteroscopic lithotripsy: a systematic review and meta-analysis.
        Urolithiasis. 2017; : 1-7
        • Jessen J.P.
        • Breda A.
        • Brehmer M.
        • Liatsikos E.N.
        • Millan Rodriguez F.
        • Osther P.J.S.
        • et al.
        International collaboration in endourology: multicenter evaluation of prestenting for ureterorenoscopy.
        J Endourol. 2016; 30: 268-273
        • Nevo A.
        • Mano R.
        • Baniel J.
        • Lifshitz D.
        Ureteric stent dwelling time: a risk factor for post-ureteroscopy sepsis.
        BJU Int. 2017; 120: 117-122
        • Palmer J.S.
        • Palmer L.S.
        POS-02.116: a simple and reliable formula for determining the proper JJ stent length in the pediatric patient: age + 10.
        Urology. 2007; 70: 264
        • Clavien P.A.
        • Barkun J.
        • de Oliveira M.L.
        • Vauthey J.N.
        • Dindo D.
        • Schulick R.D.
        • et al.
        The Clavien–Dindo classification of surgical complications: five-year experience.
        Ann Surg. 2009; 250: 187-196
        • Weinberg S.L.
        Ureteral, function. II. The ureteral catheter and the ureterometrogram.
        Invest Urol. 1985; 12: 255
        • Kinn A.C.
        • Lykkeskov-Andersen H.
        Impact on ureteral peristalsis in a stented ureter: an experimental study in the pig.
        Urol Res. 2002; 30: 213-218
        • Jones B.J.
        • Ryan P.C.
        • Lyons O.
        • Grainger R.
        • McDermott T.E.
        • ButlerR. M.R.
        Use of the double pigtail stent in stone retrieval following unsuccessful ureteroscopy.
        Br J Urol. 1990; 66: 254-256
        • Mogilevkin Y.
        • Sofer M.
        • Margel D.
        • Greenstein A.
        • Lifshitz D.
        Predicting an effective ureteral access sheath insertion: a bicenter prospective study.
        J Endourol. 2014; 28: 1414-1417
        • Hubert K.C.
        • Palmer J.S.
        Passive dilation by ureteral stenting before ureteroscopy: eliminating the need for active dilation.
        J Urol. 2005; 174 (discussion 1080): 1079-1080
        • Jayanthi V.R.
        • Arnold P.M.
        • Koff S.A.
        Strategies for managing upper tract calculi in young children.
        J Urol. 1999; 162: 1234
        • Busaidy S.S.
        • Prem A.R.
        • Medhat M.
        Paediatric ureteroscopy for ureteric calculi: a 4-year experience.
        Br J Urol. 1997; 80: 797
        • Chu L.
        • Sternberg K.M.
        • Averch T.D.
        Preoperative stenting decreases operative time and reoperative rates of ureteroscopy.
        J Endourol. 2011; 25: 751-754
        • Lumma P.P.
        • Schneider P.
        • Strauss A.
        • Plothe K.D.
        • Thelen P.
        • Ringert R.H.
        • et al.
        Impact of ureteral stenting prior to ureterorenoscopy on stone-free rates and complications.
        World J Urol. 2013 Aug; 31: 855-859
        • Blackmur J.P.
        • Maitra N.U.
        • Marri R.R.
        • Housami F.
        • Malki M.
        • McIlhenny C.
        Analysis of factors’ association with risk of postoperative urosepsis in patients undergoing ureteroscopy for treatment of stone disease.
        J Endourol. 2016 Sep; 30: 963-969
        • Lifshitz D.A.
        • Winkler H.Z.
        • Gross M.
        • Sulkes J.
        • Baniel J.
        • Livne P.M.
        Predictive value of urinary cultures in assessment of microbial colonization of ureteral stents.
        J Endurol Soc. 1999; 13: 735-738
        • Wollin T.A.
        • Tieszer C.
        • Riddell J.V.
        • Denstedt J.D.
        • Reid G.
        Bacterial biofilm formation, encrustation, and antibiotic adsorption to ureteral stents indwelling in humans.
        J Endurol Soc. 1998; 12: 101-111
        • Farsi H.M.
        • Mosli H.A.
        • Al-Zemaity M.F.
        • Bahnassy A.A.
        • Alvarez M.
        Bacteriuria and colonization of double-pigtail ureteral stents: long-term experience with 237 patients.
        J Endurol Soc. 1995; 9: 469-472
        • Turk C.
        • Knoll T.
        • Petrik A.
        • Sarica K.
        • Skolarikos A.
        • Straub M.
        • et al.
        Guidelines on urolithiasis.
        Eur Assoc Urol Guidelines. 2015;
        • Joshi H.B.
        • Stainthorpe A.
        • MacDonagh R.P.
        • Keeley Jr., F.X.
        • Timoney A.G.
        • Barry M.J.
        Indwelling ureteral stents: evaluations of symptoms, quality of life and utility.
        J Urol. 2003; 169: 1065-1069
        • Fu W.J.
        • Wang Z.X.
        • Li G.
        • Cui F.Z.
        • Zhang Y.
        • Zhang X.
        Comparison of a biodegradable ureteral stent versus the Traditional double-J stent for the treatment of ureteral injury: an experimental study.
        Biomed Mater. 2012; 7: 065002