5 Year review of ureteric stent on strings: Retrospective study at a high volume stone centre52

ABSTRACT

Introduction & Objectives: Double J ureteric stents are commonly used in acute and elective urology practice. Ureteric stents with external strings offer an alternative solution to extraction compared to the standard of requiring cystoscopy and stent removal at an additional cost. Our aim was to review the usage of double J stents on extraction strings in our institution and whether this was increasing over time and the potential cost savings. Methods: All ureteric stent insertions in Auckland Hospital between 2015 and 2019 (5 years) were reviewed from the hospital stent register. Results: A total of 4016 ureteric stents were inserted over 5 years. Of the total number of stents inserted 33.2% were stents on strings, with a significant increase in the trend towards stent on strings per year (Cochran-Armitage test p<0.0001). Procedures for stone disease were the most common indication for stent insertion making up 66% of all cases. 45% of stents inserted in management of stone disease were stents on strings. The number of stents on strings and total number of stents inserted for ureteric calculi increased each year. If a Covid test cost and subsequent flexible cystoscopy removal of ureteric stent was applied to stent on strings in our study period, a cost saving of $1.15 million would be seen, and is an important consideration for future practice worldwide. Conclusions: The use of stents on strings appears to be higher in our centre than previously reported in the literature. This is likely to be associated with reduced patient discomfort from stent removal and significantly reduced stent removal costs with implications for future planning and resource distribution in our centre. Potential risks associated with stents on strings - in particular stent dislodgement - need to be considered, and consideration given to case selection and patient counselling.