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Editorial Comment to Ureteric stents: Overview of current clinical applications and economic implications

Sali and Joshi presented an overview of ureteric stents, and discussed the complications and medical approaches to reducing ureteral stent-related symptoms. Since Zimskind et al. first reported the usefulness of ureteral stents in 1967, further development of these stents, including changes in the shape, coating and materials, has been achieved. In recent years, metallic ureteral stents (Resonance; Cook Medical, Bloomington, IN, USA) have come into use, and long-term indwelling ureteral stenting is also available. However, despite these developments, ureteral stent-related symptoms have not been completely resolved, and new issues, such as forgetting the placement of ureteral stents and stent fragmentation, have arisen. The present article comprehensively discussed the comparison of commercially available ureteral stents based on previous reports. The authors concluded that inserting an appropriate-length ureteral stent is currently the best way to reduce ureteral stent-related symptoms, as opposed to using alpha-1 blockers or drug-eluting ureteral stents. We previously reported the nomogram for estimating the ureteral length, and the correlation between the ureteral length and ureteral stent size. Based on our data, a ureteral stent size that was the same as or 1 cm shorter than the ureter, as measured using a ureteral catheter, was suggested to be associated with a minimal risk of ureteral stent migration and reduced the risk of an overlong ureteral stent. The authors also discussed the medical cost of ureteral stents causing urological complications (US$15/day/person). For urologists, the best way to resolve any issues is to prevent patients from requiring a ureteral stent altogether. However, when stent insertion cannot be avoided, urologists should take care to choose an appropriately sized ureteral stent in order to minimize ureteral stent-related symptoms.