Abstract
<title>Abstract</title> <p>Background To evaluate the impact of preoperative ureteral stenting (pre-stenting) and stent dwell time on operative outcomes, stone-free rate (SFR), and postoperative febrile urinary tract infection (fUTI) after transurethral lithotripsy (TUL). Methods We retrospectively analyzed 795 patients who underwent initial TUL for renal or ureteral stones between January 2023 and December 2024 at our institution and affiliated hospitals. Patients who underwent ureteral stenting for infectious indications were excluded. Outcomes included operative time, SFR, and postoperative fUTI. Inverse probability of treatment weighting (IPTW) was used to adjust for baseline differences between patients with and without pre-stenting. Subgroup analyses were performed according to stent dwell time (< 30 vs ≥ 30 days). Results Of the 795 patients, 229 underwent pre-stenting and 566 did not. After IPTW adjustment, pre-stenting was associated with shorter operative time (p = 0.046), whereas SFR and postoperative fUTI rates were comparable between groups. Multivariable analysis identified age, stone size, and CT attenuation value as independent predictors of SFR, whereas no independent predictors of postoperative fUTI were identified. In patients with pre-stenting, a dwell time ≥ 30 days was associated with trends toward lower SFR and higher postoperative fUTI rates, although these differences were not statistically significant. Conclusions Pre-stenting may shorten operative time but did not improve SFR or increase postoperative fUTI after adjustment for baseline differences. Routine pre-stenting may not be required without clear clinical indications, and prolonged stent dwell time should be avoided.</p>