Editing AUA: Stone Surgery (2016) (section)

==== Ureteral stenting ====
* '''Pre-intervention'''
** '''Routine stent placement is not recommended prior to URS or SWL for ureteric calculi'''
*** '''In SWL, stenting prior to treatment has not been shown to improve stone-free rates'''
**** 2019 AUA Update on Pediatric Urolithiasis: "When [SWL]used for renal stones >20 mm, a ureteral stent should be left in place to aid in stone passage and avoid steinstrasse."
*** '''In URS, stenting prior to treatment may improve stone-free rates and reduce operative times but does not override the added care costs and negative impact on quality of life associated with stents'''
* '''<span style="color:#ff0000">Post-intervention</span>'''
** '''<span style="color:#ff0000">Following URS, stent placement is strongly recommended in (5):</span>'''
**# '''<span style="color:#ff0000">Ureteric injury during URS</span>'''
**# '''<span style="color:#ff0000">Evidence of ureteral stricture or other anatomical impediments to stone fragment clearance, such as ureteral wall edema</span>'''
**# '''<span style="color:#ff0000">Large stone burden (>1.5 cm)</span>'''
**# '''<span style="color:#ff0000">Anatomically or functionally solitary kidney or renal functional impairment</span>'''
**# '''<span style="color:#ff0000">Those in whom another ipsilateral URS is planned</span>'''
*** '''Ureteral stenting may be omitted in patients without any of the features above'''; stent placement after uncomplicated URS has also been shown in randomized trials to be unnecessary
***The duration of ureteral stenting post-operatively should be minimized in order to reduce stent-related morbidity. In general, '''3-7 days of stenting is recommended following routine, uncomplicated ureteroscopic stone intervention'''
* '''α-blockers and anticholinergics therapy may be offered to reduce stent discomfort'''
** Patients should be counseled about the possibility of post-operative stent discomfort
** Other medications that can be used to alleviate stent discomfort include bladder analgesics for dysuria, non-steroidal anti-inflammatory agents, and narcotic analgesics.