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Is Stent on a String (SOS) the New Gold Standard for Post-Ureteroscopy Ureteric Drainage? Evidence from a Systematic Review - Beyond the Abstract

Ureteric stents are widely used throughout urological surgery, most commonly following ureteroscopic procedures. They provide a number of advantages but concerns over their side effects have prompted the development of alterations in their design. One of these is that of an extraction string, facilitating easy removal of the stent, without the need for cystoscopy.

We aimed to conduct an up-to-date systematic review of the available literature to assess the benefits and drawbacks of ureteric stents on strings (SOS), when compared to standard ureteric stents without strings (SWOS), in both the adult and pediatric populations. 22 studies were included, totaling 8382 patients, of which 3427 had a SOS inserted. Compared to SWOS, SOS was in situ for less time, with no significant increase in complications such as urinary tract infection or urinary symptoms. The average dwell time in adults was 6.6 days for SOS, versus 12.36 days for SWOS, resulting in a dwell time 1.87 times longer in the SWOS group. Further, significant cost savings, less pain on removal, and high rates of safe home removal have been reported in SOS when compared to SWOS. A significant drawback identified in the literature is that of stent dislodgement, which must be considered when making decisions regarding stent placement following ureteroscopy. Of particular interest, recent data from a large retrospective cohort study including over 4000 patients has suggested an increased risk of emergency department admission if SOS is in situ for less than five days. In those where the SOS was in place for five days or more, there was no significant difference between SWOS and SOS. Further data from randomised control trials is required to identify optimal stenting practice. Although their use seems to be still restricted in current endourology practices, they are likely to become the new gold standard in the future with more shared decision making and patient-reported outcome measures coming into the mainstream.

Written by: Nick Harrison,1 Charlotte Hughes,2 Bhaskar K Somani3

  1. Mersey and West Lancashire Teaching Hospitals NHS Trust, Urology, Warrington, United Kingdom of Great Britain and Northern Ireland
  2. Norfolk and Norwich University Hospitals NHS Foundation Trust, Urology, Norwich, Norfolk, United Kingdom of Great Britain and Northern Ireland
  3. University Hospital Southampton NHS Foundation Trust, Urology, Southampton, United Kingdom of Great Britain and Northern Ireland
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