Does ureteral stenting prior to shock wave lithotripsy influence the need for intervention in steinstrasse and related complications?

Objective: To analyze factors affecting steinstrasse (SS) and study the impact of pre-shock wave lithotripsy (SWL) stenting in the prevention of SS and related complications. Patients and Methods: The cohort included 4,644 patients with renal stones treated by SWL. Three hundred and twenty-six (7%) developed SS. Initially, all patients were managed conservatively (group 1); interventions were reserved for those in whom conservative treatment failed (group 2). The 2 groups were further analyzed to identify factors influencing the need for intervention. The impact of pre-SWL stenting on the development of SS and the need for intervention was also assessed. Results: Expectant management was successful in 176 (54%) patients, while 150 (46%) required intervention for SS. The size of the stones had a significant association with the number of sessions required (p < 0.01) and the development of SS. The placement of a stent prior to SWL decreased neither the sessions of SWL (p < 0.01) nor the interventions required for SS and related complications. Conclusions: SWL for larger stones is a potentially significant complication of SWL and is associated with significant morbidity. Ureteral stents decrease the acute presentations of patients with SS; however, it does not decrease the ultimate need for intervention in the management of SS.