Soft ureteral stents significantly reduce stent-related symptoms compared to firm ureteral stents: a prospective, randomized trial.

BACKGROUND

Double-J stents are commonly inserted following ureteroscopy and stone lithotripsy, potentially leading to various urinary and pain-related symptoms and affecting patients' quality of life. This study aimed to compare the impact of soft and firm silicone stents on stent-related symptoms in patients undergoing ureteroscopy and stone lithotripsy.

METHODS

After receiving institutional ethical committee approval (SMC 0119-23), we conducted a prospective, randomized, single-blinded trial between 2023-2024. Patients undergoing ureteroscopy and stone lithotripsy were randomized into two groups: those receiving a soft polymer stent (Universa®, Cook Medical, Bloomington, IN, USA) or a firm polymer stent (Percuflex®, Boston Scientific, Marlborough, MA, USA). Symptoms were assessed using the Ureteral Stent Symptoms questionnaire (USSQ), completed upon stent removal, 14 days postoperatively. The primary outcome was the USSQ index score, with secondary outcomes including individual USSQ domain scores.

RESULTS

A total of 120 patients completed the questionnaire. The soft-stent group (N.=60) demonstrated significantly lower USSQ index scores (26 vs. 73, P<0.001) and improved outcomes across all USSQ sub-domains (P<0.001) compared to the firm-stent group. A multiple regression model confirmed that using firm stent material independently resulted in higher USSQ index scores (P<0.001) relative to soft stent. Intraoperative and postoperative complication rates were similar between groups.

CONCLUSIONS

Using soft ureteral stents results in fewer stent-related symptoms compared to firm stents, offering superior quality of life while maintaining a comparable safety profile. Based on these findings, when placing a ureteral stent following ureteroscopy and stone lithotripsy, a soft stent is recommended.