Does Passive Ureteral Dilation Matter? Outcomes of Retrograde Intrarenal Surgery in Pre-Stented Versus Stent-Naïve Patients: A Retrospective Cohort Study

Abstract

Background: Passive ureteral dilation achieved through pre-operative Double-J (DJ) ureteral stenting may facilitate ureteral access during retrograde intrarenal surgery (RIRS). However, the routine use of pre-stenting remains controversial because of conflicting evidence regarding its effect on surgical outcomes. This study compared the perioperative outcomes of RIRS in pre-stented and stent-naïve patients.

Methods: A retrospective cohort study was conducted in the Department of Urology, Meenakshi Medical College Hospital & Research Institute, Kanchipuram, Tamil Nadu, India. Medical records of 80 adult patients who underwent RIRS for renal calculi between January 2022 and December 2025 were reviewed. Patients were divided into a pre-stented group (n = 38) and a stent-naïve group (n = 42). The primary outcome was successful ureteral access sheath (UAS) placement. Secondary outcomes included operative duration, stone-free rate, postoperative complications, length of hospital stay, and the need for secondary procedures. Statistical analysis was performed using Student's t-test, the chi-square test, Fisher's exact test, and multivariable logistic regression; p < 0.05 was considered statistically significant.

Results: Baseline demographic and stone characteristics were comparable between the two groups (p > 0.05). Successful UAS placement was significantly higher in the pre-stented group than in the stent-naïve group (97.4% vs. 81.0%; p = 0.024). The requirement for intraoperative ureteral dilation was significantly lower in pre-stented patients (5.3% vs. 26.2%; p = 0.011). Mean operative duration was significantly shorter in the pre-stented group (59.8 ± 13.4 vs. 69.5 ± 15.8 minutes; p = 0.004), and hospital stay was reduced (1.4 ± 0.6 vs. 1.9 ± 0.8 days; p = 0.003). Although stone-free rates (92.1% vs. 85.7%; p = 0.37), secondary procedures (5.3% vs. 14.3%; p = 0.18), and overall complication rates (10.5% vs. 21.4%; p = 0.18) favored the pre-stented group, these differences were not statistically significant. Multivariable logistic regression identified pre-operative stenting as an independent predictor of successful UAS placement (adjusted OR = 6.82; 95% CI: 1.18–39.41; p = 0.032).

Conclusion: Pre-operative ureteral stenting significantly improves ureteral access sheath placement, reduces the need for active ureteral dilation, shortens operative time, and decreases hospital stay during RIRS. However, routine pre-stenting does not significantly improve stone-free rates or reduce postoperative complications. Selective pre-operative stenting should be considered in patients with anticipated difficult ureteral access rather than adopted as a routine strategy.