Stent on a string: a potential new gold standard for postureteroscopy ureteral drainage

A recent study indicated that stent on string (SOS) is a great alternative following ureteroscope (URS), particularly for patients without intraoperative complications, and they are typically inserted as a routine based on surgeon preference. These stents decrease pain, cost, dwell time, risks, and the suffering associated with prolonged stenting, and most patients are satisfied to remove them at home. While their use is currently limited in endourology practices, they are expected to become the standard for routine URS in the future. The findings of this study were published in the Journal of Endourology.

An extensive systematic review was carried out across several databases, utilizing the preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology. This review targeted studies published in English that involved patients of all age groups with SOS after undergoing ureteroscopy (URS) for the management of stone disease. A total of 22 studies (20 involving adults and 2 involving pediatric patients) were included from the 1210 records identified, including 8382 patients. Among these patients, 3427 (40.9%) had stent on string inserted and 434 (11%) were in the pediatric age group.

Study results showed that SOS presents several advantages, and when compared with stents without strings (SWOSs), they were implanted for a shorter period, with no significant differences in complications such as urinary tract infection or urinary symptoms. Moreover, SOS showed notable cost savings, decreased pain upon removal, and a high incidence of successful home removal, with more than 90% of patients indicating their readiness to remove their SOSs at home. However, it is important to consider the minor risk of stent dislodgment when deciding on SOS placement post-URS.

The above study demonstrated that SOS is an excellent option after URS, especially for patients who do not experience intraoperative complications. Surgeons typically insert these stents based on their preference as part of routine practice. The use of these stents reduces cost, pain dwell time, risks, and the discomfort associated with prolonged stenting. Many patients are happy to have them removed at home. The use of SOS is currently limited in endourology, it is anticipated that they will become the gold standard for routine ureteroscope in the future.