Pre-Stenting: Is Smaller Better? A Multicentric Evaluation of 4.8 F and 6 F JJ Stents in Retrograde Intrarenal Surgery.

Background and Objectives: In this study, we aimed to compare the effects of 4.8 F and 6 F JJ stents on irritative symptoms and success rate in patients with a preoperative JJ stent prior to RIRS. Materials and Methods: A total of 316 patients who underwent JJ stent implantation prior to retrograde intrarenal surgery were retrospectively analyzed. Patients were classified into Group 1 (4.8 F stent) and Group 2 (6 F stent) based on stent diameter. Urinary symptoms prior to the insertion of the JJ stent and the day before RIRS were evaluated using the Quality of Life (QoL) score (VAS), International Prostate Symptom Score (IPSS), and Visual Analog Scale. The groups were compared in terms of demographic data, stone characteristics, perioperative data, length of stay, complications, stone-free rates (SFRs) and change in total VAS score, IPSS and QoL. Results: The patients' demographic data and the stone characteristics of the two groups were similar. There was no statistical difference between groups in the SFR, length of stay, or total complication rates (p = 0.5, p = 0.159, and p = 0.13, respectively). Operation time was similar between the groups (p = 0.13). Although the change in total VAS scores was similar between the two groups (p = 0.1), QoL was higher in Group 1 compared with Group 2 (p < 0.001). Group 2 demonstrated worse outcomes in total IPSS, as well as in the storage subscores (Q2, Q4, and Q7) and voiding symptom subscores (Q1, Q3, Q5, and Q6), with all comparisons showing statistical significance (p < 0.001 for each). Conclusions: Varying calibers of JJ stents have comparable success rates and complication outcomes. However, when the stent caliber is reduced, patients experience better QoL and fewer lower urinary tract symptoms. Smaller-diameter stents were associated with significantly better symptom-related outcomes without compromising surgical success.