Optimal Timing for Ureteral Stent Removal After Ureteroscopy to Minimize Morbidity: A Single-Center Prospective Comparative Study.

OBJECTIVE: To compare patient-reported morbidity across three ureteral stent removal protocols after ureteroscopy (URS) and holmium laser lithotripsy.

PATIENTS AND METHODS: We prospectively recruited 180 patients undergoing URS for unilateral ureteric or renal stones (1-1.5 cm) from January 2021 to December 2024 at a single academic center. All procedures were performed by a single surgeon using a semirigid or flexible ureteroscope, holmium laser lithotripsy, and placement of a 6Fr × 26 cm double-J stent. Patients were sequentially allocated into three groups based on stent removal timing: Group A (24-48 h, n = 60), Group B (3-5 days, n = 60), and Group C (7-14 days, n = 60). The primary outcome was the Ureteral Stent Symptom Questionnaire (USSQ) total score. Secondary outcomes included Visual Analog Scale (VAS) pain score at Day 7, opioid tablet consumption, complication rates (Clavien-Dindo), patient satisfaction (1-10 scale), and days to return to normal activities. Propensity score analysis was performed to adjust for potential confounding.

RESULTS: Baseline characteristics were similar across groups. Group A had the lowest USSQ total score (68.4 ± 12.6 vs. 76.8 ± 13.4 in Group B vs. 89.7 ± 15.2 in Group C; p < 0.001). VAS pain score at Day 7 was also lowest in Group A (2.1 ± 1.2 vs. 3.9 ± 1.5 in Group B vs. 4.8 ± 1.8 in Group C; p < 0.001). Opioid tablets consumed were fewer in Group A (2.3 ± 2.1 vs. 5.6 ± 2.9 in Group B vs. 8.4 ± 3.6 in Group C; p < 0.001). Complication rates did not differ significantly between groups (p = 0.42). Patient satisfaction was highest in Group A (8.9 ± 1.1 vs. 7.5 ± 1.4 in Group B vs. 6.2 ± 1.8 in Group C; p < 0.001), and return to normal activities was fastest in Group A (3.2 ± 1.4 vs. 5.9 ± 1.9 in Group B vs. 8.7 ± 2.3 days in Group C; p < 0.001). On multivariable analysis, longer stent duration was the strongest independent predictor of higher USSQ score (β = 0.42, p < 0.001), followed by female sex (β = 0.18, p = 0.02) and age under 50 years (β = 0.15, p = 0.04).

CONCLUSION: In this prospective comparative study, stent removal at 24-48 h was associated with lower morbidity, earlier return to activities, and higher patient satisfaction compared to later removal, without an observed increase in complications. These findings suggest that early removal may be beneficial in appropriately selected patients without contraindications. Removal at 3-5 days may represent a practical alternative when earlier removal is not feasible. Adequately powered randomized trials are needed to confirm these findings.