Safety of omitting postoperative urethral catheterization after ureteroscopic lithotripsy under general anesthesia: A single-center retrospective study

Safety of omitting postoperative urethral catheterization after ureteroscopic lithotripsy under general anesthesia: A single-center retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Safety of omitting postoperative urethral catheterization after ureteroscopic lithotripsy under general anesthesia: A single-center retrospective study Naoki Ito, Shigetaka Suekane, Tsukasa Igawa This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8571812/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract We evaluated the safety and feasibility of omitting postoperative urethral catheterization after ureteroscopic lithotripsy under general anesthesia. Data from 77 patients who underwent ureteroscopic lithotripsy for upper urinary tract stones between June 2023 and September 2025 were retrospectively reviewed and categorized according to postoperative urethral catheter placement. Perioperative outcomes, including postoperative pain, hematuria, febrile urinary tract infection, and urinary retention, were compared between the groups, and multivariate logistic regression analysis was performed to identify independent predictors of postoperative complications. Patients who underwent postoperative catheterization were significantly older and had longer operative times than those without catheterization. Absence of postoperative urethral catheterization was independently associated with a higher risk of high-grade hematuria; however, the hematuria was transient and clinically insignificant. No significant differences were observed in postoperative pain, febrile urinary tract infection, or urinary retention. These findings indicate that omission of postoperative urethral catheterization after ureteroscopic lithotripsy under general anesthesia is generally safe and does not increase the risk of infection or urinary retention. Routine catheterization appears unnecessary, and selective use may be sufficient in clinical practice. general anesthesia hematuria postoperative management ureteroscopic lithotripsy urethral catheter Figures Figure 1 Figure 2 Introduction Ureteroscopic lithotripsy (URSL) is the standard treatment for upper urinary tract stones [ 1 , 2 ]. Traditionally, postoperative urethral catheter (UC) placement following URSL is performed to prevent postoperative urinary retention and urinary tract infections (UTIs), and to monitor for hematuria. However, UC placement is associated with increased risks of catheter-related complications, such as discomfort, infection, and urethral injury [ 3 ], and its omission may improve postoperative recovery and patient comfort. The European Association of Urology and American Urological Association guidelines for urolithiasis recommend the use of ureteral stents after surgery for urinary tract stones [ 1 , 2 ]. However, no guidelines exist regarding postoperative urethral catheterization. Similarly, the Japanese Urological Association Guidelines for Urolithiasis (2022) do not specify whether a UC should be placed after URSL [ 4 ], resulting in variability in postoperative management among institutions. Therefore, the safety and feasibility of omitting postoperative UC after URSL remains unclear. Accordingly, this study aimed to evaluate these aspects to address this gap in knowledge. Methods Study design and population We retrospectively reviewed data from 110 patients who underwent URSL for upper urinary tract stones at Kurume University Medical Center between June 2023 and September 2025. Patients who underwent procedures under spinal anesthesia (n = 8) were excluded. Additionally, patients who underwent subsequent URSL for the same stone (n = 14), underwent simultaneous surgery for bladder stones (n = 5), had difficulty with postoperative pain assessment due to dementia or stroke (n = 3), or had incomplete data (n = 3) were further excluded. The remaining patients, all of whom underwent URSL under general anesthesia, were included in the final analysis. All surgeries were performed by a single experienced urologist to minimize inter-operator variability. Patients were divided into two groups according to postoperative UC placement: With-UC and Without-UC groups. UC placement was determined at the discretion of the primary surgeon, based on intraoperative findings and the patient’s condition. This study was approved by the Institutional Review Board of Kurume University Medical Center (Approval No. 2025-05). Opt-out consent was used in accordance with institutional policy. The following perioperative parameters were evaluated: age, sex, stone laterality, stone size, stone-free rate, operative time, total laser energy, postoperative hospital stay, postoperative pain assessed using a numeric rating scale (NRS), maximum hematuria grade, febrile UTI, and urinary retention. Stone size was defined as the largest diameter for solitary calculi, and as the sum of maximal diameters for multiple calculi. Volume was calculated as total stone burden using the formula: length × width × height × 0.167 × π [ 5 ]. The severity of hematuria was graded on a 6-point visual scale according to the postoperative color of urine: Grade 0, clear urine; Grade 1, almost clear urine with only a faint pink tinge; Grade 2, light reddish urine; Grade 3, visibly red urine; Grade 4, dark red urine; and Grade 5, gross hematuria with a dark, almost black urine. These grades correspond to the approximate visual urine color intensity used in clinical assessments and have been routinely employed at our institution for postoperative evaluation. High-grade hematuria was defined as grade 3 or higher. Surgical procedure All procedures were performed under general anesthesia. Semi-rigid ureteroscopy was performed using the Olympus WA2UR11A ureteroscope (Olympus, Tokyo, Japan), and flexible ureteroscopy was conducted using either the Olympus URF-P7 (Olympus, Tokyo, Japan) or the Boston Scientific LithoVue Elite (Boston Scientific, Marlborough, MA, USA). A ureteral access sheath was routinely used in all cases involving renal stones. The LithoVue Elite was preferentially selected for cases with large stone burdens (≥ 20 mm). Laser lithotripsy was performed using the Lumenis Pulse™ 120H high-power holmium:YAG laser system (Lumenis, Yokneam, Israel). Energy settings ranged from 0.2 to 1.5 J with frequencies of 5 to 80 Hz. A 200-µm disposable laser fiber was used in most cases, while a reusable 200-µm fiber was occasionally used for small stones. Both dusting and fragmentation techniques were applied depending on stone characteristics. The dusting mode was defined as low energy and high frequency (< 1 J, ≥ 20 Hz), whereas the fragmentation mode was defined as higher energy and lower frequency (≥ 0.8 J, ≤ 20 Hz). These techniques were applied using both laser fiber types. Postoperative ureteral stenting was routinely performed using either the Tria stent (Boston Scientific) or the Inlay Optima stent (Bard, Murray Hill, NJ, USA). Statistical analysis Continuous variables were compared using the Mann–Whitney U test, and categorical variables were analyzed using Fisher’s exact test. Multivariate logistic regression analysis was performed to identify independent predictors of postoperative high-grade hematuria. Statistical significance was set at P < 0.05. All analyses were conducted using JMP Pro 18 software (SAS Institute, Cary, NC, USA). Results A total of 77 patients met the inclusion criteria and were included in the final analysis (Fig. 1 ). A total of 110 patients underwent ureteroscopic lithotripsy (URSL) during the study period. After excluding 33 patients, 77 patients were included in the final analysis, including 52 patients without postoperative urethral catheterization and 25 patients with postoperative urethral catheterization. Of these, 52 (67.5%) were categorized into the Without-UC group and 25 (32.5%) into the With-UC group. Patients in the With-UC group were significantly older (median, 70 vs. 64 years; P = 0.035) and had a higher number of stones (P = 0.002) than those in the Without-UC group. No significant differences were observed between the groups regarding sex, comorbidities, and the size, location, and type of stones (Table 1 ). Table 1 Baseline characteristics of patients undergoing ureteroscopic lithotripsy. Total (n = 77) Without UC (n = 52) With UC (n = 25) P value Age (years) 67 (58–76) 64 (57–74) 70 (61–83) 0.035* Sex Male 36 (46.8) 25 (48.1) 11 (44.0) 0.737 Female 41 (53.3) 27 (51.9) 14 (56.0) BMI (kg/m²) 23.3 (21.0–26.3) 23.1 (20.7–25.9) 23.3 (21.6–26.7) 0.959 PS 0,1 72 (93.5) 50 (96.2) 22 (88.0) 0.118 2 3 (3.9) 2 (3.9) 1 (4.0) 3,4 2 (2.6) 0 (0.0) 2 (8.0) Comorbidities Hypertension 36 (46.8) 23 (44.2) 13 (52.0) 0.522 Diabetes mellitus 8 (10.4) 5 (9.6) 3 (12.0) 0.748 Cardiovascular disease 3 (3.9) 1 (1.9) 2 (8.0) 0.197 Oral anticoagulants 8 (10.4) 4 (7.7) 4 (16.0) 0.263 Total stone volume (cm³) 0.50 (0.25–1.21) 0.48 (0.18–1.31) 0.63 (0.31–1.05) 0.266 CT attenuation (HU) 1180 (893–1375) 1216 (881–1375) 1102 (919–1377) 0.623 Stone location R2–R3 26 (33.8) 18 (34.6) 8 (32.0) 0.956 U1 25 (32.4) 17 (32.7) 8 (32.0) U2–U3 26 (33.8) 17 (32.7) 9 (36.0) Number of stones 1 44 (57.1) 36 (69.2) 8 (32.0) 0.002* 2 16 (20.8) 10 (19.2) 6 (24.0) ≥ 3 17 (22.1) 6 (11.6) 11 (44.0) Stone composition Calcium oxalate 56 (72.7) 36 (69.2) 20 (80.0) 0.280 Calcium phosphate 8 (10.4) 6 (11.5) 2 (8.0) Carbonate Apatite 1 (1.3) 0 (0.0) 1 (4.0) Uric acid 2 (2.6) 2 (3.9) 0 (0.0) Unknown 10 (13.0) 8 (15.4) 2 (8.0) Values ​​are presented as numbers (%) or median (interquartile range). BMI, body mass index; CT, computed tomography; HU, Hounsfield units; PS, performance status; UC, urethral catheter. Furthermore, the operative time was significantly longer in the With-UC group (median: 94 min vs. 69 min; P = 0.007). Total laser energy, complete stone clearance rate, postoperative hospitalization duration, and the incidence of febrile UTI or pain were comparable between the groups (Table 2 ). Table 2 Perioperative outcomes according to postoperative urethral catheterization status. Total (n = 77) Without UC (n = 52) With UC (n = 25) P value Type of ureteroscope Rigid only 29 (37.7) 23 (44.2) 6 (24.0) 0.086 Rigid and flexible 48 (62.3) 29 (55.8) 19 (76.0) Operative time (min) 78 (48–104) 69 (35–95) 94 (66–112) 0.007* Total laser energy (kJ) 1.63 (0.31–7.49) 1.34 (0.17–7.39) 3.20 (1.38–9.94) 0.219 Stone-free 63 (82.9) 42 (82.4) 21 (84.0) 0.858 Postoperative hospital stays (days) 4 (2–5) 3 (2–5) 4 (3–6) 0.649 Postoperative febrile UTI 11 (14.3) 6 (11.5) 5 (20.0) 0.320 Maximum hematuria grade 0–2 42 (54.6) 24 (46.2) 18 (72.0) 0.029* 3 25 (32.5) 18 (34.6) 7 (28.0) 4 10 (12.9) 10 (28.0) 0 (0.0) Decrease in hemoglobin (g/dL) 0.9 (0.4–1.6) 1.0 (0.4–1.7) 0.6 (0.4–1.3) 0.208 Maximum postoperative NRS 0–3 48 (62.3) 30 (57.7) 18 (72.0) 0.425 4–6 19 (24.7) 15 (28.9) 4 (16.0) 7–10 10 (13.0) 7 (13.4) 3 (12.0) Use of postoperative analgesics 34 (44.2) 25 (48.1) 9 (36.0) 0.318 Use of postoperative antiemetics 1 (1.3) 0 (0.0) 1 (4.0) 0.147 Postoperative urinary retention 1 (1.3) 1 (1.9) 0 (0.0) 0.485 Postoperative fall events 0 (0.0) 0 (0.0) 0 (0.0) – Values ​​are presented as numbers (%) or median (interquartile range). UC, urethral catheter; NRS, numeric rating scale; UTI, urinary tract infection. The Without-UC group had a higher proportion of grade 3–4 hematuria than the With-UC group (62.6% vs. 28.0%; P = 0.029; Fig. 2 ). Stacked bar charts show the relative frequency of postoperative hematuria grades in patients with and without postoperative urethral catheterization. In the multivariate logistic regression analysis, the absence of postoperative urethral catheterization (odds ratio, 3.606, 95% CI, 1.182–12.365; P = 0.024; Table 3 ) was an independent risk factor for severe hematuria. Table 3 Multivariate logistic regression analysis of factors associated with high-grade postoperative hematuria. Risk factor Risk category Univariate analysis Multivariate analysis Odds ratio (95% CI) P value Odds ratio (95% CI) P value Age (years) > 65 0.431 (0.168–1.075) 0.071 0.659 (0.238–1.845) 0.423 Sex Male 1.654 (0.667–4.171) 0.278 Oral anticoagulants Yes 2.241 (0.509–11.642) 0.286 Prior ureteral stent placement Yes 0.467 (0.156–1.292) 0.144 Stone location Kidney (R2–R3) 1.973 (0.753–5.298) 0.167 Total stone volume (cm³) ≥ 0.5 1.169 (0.469–2.931) 0.738 CT attenuation (HU) ≥ 1180 1.063 (0.426–2.660) 0.896 Number of stones ≥ 3 0.604 (0.189–1.805) 0.371 Postoperative UC placement Without 2.893 (1.064–8.557) 0.037* 3.606 (1.182–12.365) 0.024* Postoperative ureteral stent placement Yes 0.517 (0.066–3.299) 0.479 Type of ureteroscope Flexible 0.633 (0.245–1.608) 0.336 Operation time (min) ≥ 80 2.376 (0.952–6.122) 0.064 2.992 (1.068–9.041) 0.037* Total energy (kJ) ≥ 1.44 1.417 (0.523–3.902) 0.493 Intraoperative complications ureteral injury 0.606 (0.028–6.595) 0.682 Odds ratios are presented with 95% confidence intervals. UC, urethral catheter; OR, odds ratio; CI, confidence interval. However, no significant difference was observed in the decrease in hemoglobin levels (median, 1.0 vs. 0.6 g/dL, P = 0.208; Table 2 ), suggesting that the hematuria was not clinically significant. Discussion Urethral catheterization is widely performed after URSL to prevent urinary retention, bladder discomfort, and hematuria. However, catheter placement has several potential disadvantages, including urethral trauma, urinary tract infection (UTI), allergic reactions to latex materials, and prolonged bed rest [ 3 , 6 ]. Additionally, it can lead to catheter-related bladder discomfort, which significantly affects postoperative comfort [ 7 ]. Although several clinical trials have investigated approaches to prevent postoperative catheter-related bladder discomfort [ 8 , 9 ], no standard management has been established, with the most effective preventive measure being omission of UC placement. Globally, more than 100 million catheters are used annually [ 10 ], unnecessary catheterization imposes environmental and financial burdens on healthcare systems. Efforts to reduce unnecessary UC use are crucial [ 11 ], and routine UC placement after URSL should be reconsidered. Current international clinical guidelines for the management of urinary stones lack clear recommendations for postoperative UC placement after URSL [ 1 , 2 ]. A similar approach is adopted in Japanese guidelines [ 4 ], where the decision is left at the discretion of individual institutions. Therefore, in clinical practice, postoperative management is often determined based on factors such as the type of anesthesia used and the patient’s background. As detrusor muscle contraction is completely suppressed under spinal anesthesia and partially suppressed by general anesthesia, postoperative urinary retention occurs more frequently after spinal anesthesia than after general anesthesia [ 12 , 13 ]. Herein, we only included patients who underwent URSL under general anesthesia. Consistently, postoperative urinary retention was observed in only one patient in the Without-UC group, which was attributed to a fear of painful urination rather than the anesthetic effect, confirming that the risk of urinary retention did not increase following omission of UC placement. In a large multicenter retrospective study involving 11,885 URSL procedures, intraoperative hematuria was reported in approximately 15% of cases; however, most of these cases were mild and clinically insignificant, requiring no intervention [ 14 ]. In the present study, none of the patients required bladder irrigation, blood transfusion, or other interventions for the management of hematuria. However, patients who did not undergo postoperative urethral catheterization had significantly higher hematuria grades than those who underwent catheter placement. Additionally, the omission of postoperative urethral catheterization and a longer operative time were identified as independent risk factors for postoperative hematuria. Herein, the hematuria was transient and most commonly observed at the time of first voiding. This may be attributed to urethral bleeding during spontaneous voiding and the absence of postoperative bladder irrigation. Importantly, the decrease in hemoglobin levels did not differ between the two groups, suggesting that the observed hematuria had limited clinical significance. Regarding postoperative management, the current findings do not contradict the safety of urethral catheterization omission in select cases. Collectively, these findings suggest that, in most cases, catheter placement can be omitted under careful postoperative observation. Herein, patients in the With-UC group were significantly older, which likely reflects a tendency of clinicians to place urethral catheters more frequently in older patients with reduced activities of daily living (ADL) or a higher perceived risk of postoperative infection. Additionally, the number of stones was higher in the With-UC group, which may have indirectly influenced the decision regarding UC placement. As all procedures were performed by a single surgeon, this difference was not attributable to interoperator variation. Rather, patients with multiple stones tended to require longer operative times, which might have led to a greater concern for postoperative infection and, consequently, a higher rate of UC placement. However, in the multivariate analysis, the number of stones was not associated with postoperative complications, indicating that this factor had limited clinical relevance in the present context. Very few studies have specifically examined the relationship between post-URSL UC placement and potential associated complications, such as febrile UTI, postoperative pain, or hematuria. Previous studies have identified older age, diabetes mellitus, prolonged operative time, positive preoperative urine culture, and postoperative ureteral stent placement as independent risk factors for febrile UTI after URSL [ 15 ]. Moreover, postoperative pain correlates with younger age and postoperative ureteral stent placement [ 16 , 17 ]. However, none of these studies examined UC placement. In the present study, no significant differences were observed in postoperative pain, febrile UTI, or hospitalization duration between the groups. In a recent prospective randomized study comparing UC placement following ureteroscopic examination and JJ stent insertion, Sener et al. reported no significant difference in visual analog scale scores between groups; however, the “Total Body Pain” score on the Ureteric Stent Symptom Questionnaire was significantly lower in the catheterized group, suggesting a potential benefit of temporary postoperative catheterization in reducing overall pain perception [ 18 ]. In contrast, regarding URSL, Hori et al. conducted a retrospective analysis and demonstrated that the omission of urethral catheterization after URSL resulted in a lower incidence of febrile UTI in the non-catheterized group, supporting the safety of catheter-free postoperative management [ 19 ]. Likewise, Pawłowska-Krajka et al. performed a prospective trial involving patients who underwent URSL under spinal anesthesia and observed that postoperative pain was significantly milder in patients without UC placement [ 20 ]. Collectively, these findings indicate that urethral catheterization after URSL can be safely omitted in appropriate cases, and that selective rather than routine UC placement may improve postoperative comfort. The results of the present study are consistent with those of previous reports demonstrating that the omission of postoperative urethral catheterization does not increase the incidence of postoperative complications, such as fever, pain, or urinary retention, and can be managed safely. Overall, these results suggest that routine postoperative urethral catheterization after URSL performed under general anesthesia may not be necessary, and its omission can be considered in select cases. This study has several limitations. First, this is a retrospective, single-center analysis with a relatively small sample size, which may limit the generalizability of the findings. Second, although all surgeries were performed by a single experienced urologist, which reduced operator-related bias, differences in patient background between the groups may have influenced the outcomes. Third, postoperative pain was assessed using a general NRS that did not specifically reflect catheter-related discomfort. Finally, hematuria grades were visually assessed by the nursing staff, which may have introduced observer variability. Despite these limitations, this study provides novel insights, focusing exclusively on URSL performed under general anesthesia, which have rarely been reported. Further multicenter prospective studies are warranted to corroborate these findings. Declarations Author Contributions NI: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing–original draft preparation. SS: Supervision, Validation, Writing–review & editing. TI: Supervision, Project administration, Writing–review & editing. All authors reviewed and approved the final version of the manuscript prior to submission. Data availability The datasets generated and analyzed during the current study are not publicly available due to institutional policies and patient privacy regulations but are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no competing interests. Ethics approval This study was approved by the Institutional Review Board of Kurume University Medical Center (IRB No. 2025-05). Informed consent Opt-out consent was used in accordance with institutional policy. References Skolarikos A, Geraghty R, Samani B, Tailly T, Jung H, Neisius A et al (2025) European Association of Urology Guidelines on the Diagnosis and Treatment of Urolithiasis. Eur Urol 88(1):64–75 Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP et al (2016) Surgical management of stones: American Urological Association/Endourological Society guideline, part II. J Urol 196(4):1161–1169 Dellimore KH, Helyer AR, Franklin SE (2013) A scoping review of important urinary catheter induced complications. J Mater Sci Mater Med 24(8):1825–1835 Miyazawa K, Yamaguchi S, Iguchi T, Chikazawa I, Yasui T, Takahashi S et al (2025) Summary of the clinical practice guideline for the management of urinary stones, third edition. Int J Urol 32(5):462–474 Panthier F, Kutchukian S, Ducousso H, Doizi S, Solano C, Candela L et al (2024) How to estimate stone volume and its use in stone surgery: a comprehensive review. Actas Urol Esp (Engl Ed) 48(1):71–78 Nollen JM, Pijnappel L, Schoones JW, Peul WC, Van Furth WR, Brunsveld-Reinders AH (2023) Impact of early postoperative indwelling urinary catheter removal: a systematic review. J Clin Nurs 32(9–10):2155–2177 Bai Y, Wang X, Li X, Pu C, Yuan H, Tang Y et al (2015) Management of catheter-related bladder discomfort in patients who underwent elective surgery. J Endourol 29(6):640–649 Wang Z, Li H, Wang Y, Li Y, Li L, Zhang L et al (2025) Esketamine for preventing catheter-related bladder discomfort after ureteroscopic lithotripsy: A randomized controlled trial. BMC Anesthesiol 25(1):361 Agarwal A, Dhiraaj S, Singhal V, Kapoor R, Tandon M (2006) Comparison of efficacy of oxybutynin and tolterodine for prevention of catheter related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study. Br J Anaesth 96(3):377–380 Cameron AP, Werneburg GT (2025) Foley catheter management: a review. JAMA Surg 160(6):701–707 Fakih MG, Watson SR, Greene MT, Kennedy EH, Olmsted RN, Krein SL et al (2012) Reducing inappropriate urinary catheter use: a statewide effort. Arch Intern Med 172(3):255–260 Baldini G, Bagry H, Aprikian A, Carli F (2009) Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology 110(5):1139–1157 Pavlin DJ, Pavlin EG, Gunn HC, Taraday JK, Koerschgen ME (1999) Voiding in patients managed with or without bladder catheterization during outpatient surgery. Anesth Analg 88:581–585 Tanriverdi O, Silay MS, Kadihasanoglu M, Aydin M, Kendirci M, Miroglu C (2012) Revisiting the predictive factors for intra-operative complications of rigid ureteroscopy: a 15-year experience. Urol J 9(2):457–464 Bhojani N, Miller LE, Bhattacharyya S, Cutone B, Chew BH (2021) Risk factors for urosepsis after ureteroscopy for stone disease: A systematic review with meta-analysis. J Endourol 35(7):991–1000 Pengfei S, Yutao L, Jie Y, Wuran W, Yi D, Hao Z et al (2011) The results of ureteral stenting after ureteroscopic lithotripsy for ureteral calculi: a systematic review and meta-analysis. J Urol 186(5):1904–1909 Gul Z, Alazem K, Li I, Monga M (2016) Predicting procedural pain after ureteroscopy: does hydrodistention play a role? Int. Braz. J Urol 42(4):734–739 Sener TE, Ozgur G, Cetin M, Pietropaolo A, Tzelves L, Esperto F et al (2025) Foley catheter after ureteroscopy and JJ stent placement: a randomised prospective European Association of Urology Section of Urolithiasis-Young Academic Urologists (EULIS-YAU) endourology study. BJU Int 135(1):95–102 Hori S, Otsuki H, Fujio K, Nakajima K, Mitsui Y (2022) Impact of eliminating urethral catheterization following ureterorenoscopic lithotripsy. Int. J. Urol 29(4):337–342 Pawłowska-Krajka E, Dorobek A (2017) The impact of urinary bladder catheterisation after ureterorenoscopic stone removal on the postoperative course. Cent European J Urol 70(4):405–411 Additional Declarations No competing interests reported. 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12:48:43","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":90683,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8571812/v1/fc6bed38adca3fecbd3f35bd.html"},{"id":100684621,"identity":"73be8c04-651f-41ad-83e3-e8d8988235c5","added_by":"auto","created_at":"2026-01-20 12:44:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":40807,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of patient selection and grouping.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8571812/v1/19823b40002bb3cb16619457.png"},{"id":100684855,"identity":"75981f87-c848-4361-b147-72023cbe8fd9","added_by":"auto","created_at":"2026-01-20 12:46:48","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":38848,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of postoperative hematuria grades according to urethral catheterization status.\u003c/p\u003e\n\u003cp\u003eStacked bar charts show the relative frequency of postoperative hematuria grades in patients with and without postoperative urethral catheterization.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8571812/v1/0bca57932646be2edaca6769.png"},{"id":103030207,"identity":"7d5628d0-76ca-4872-bc26-35a715a94cf0","added_by":"auto","created_at":"2026-02-19 21:54:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":733135,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8571812/v1/4e843edf-a27a-4df2-b1f9-d242d2f35dba.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Safety of omitting postoperative urethral catheterization after ureteroscopic lithotripsy under general anesthesia: A single-center retrospective study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUreteroscopic lithotripsy (URSL) is the standard treatment for upper urinary tract stones [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Traditionally, postoperative urethral catheter (UC) placement following URSL is performed to prevent postoperative urinary retention and urinary tract infections (UTIs), and to monitor for hematuria. However, UC placement is associated with increased risks of catheter-related complications, such as discomfort, infection, and urethral injury [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], and its omission may improve postoperative recovery and patient comfort.\u003c/p\u003e \u003cp\u003eThe European Association of Urology and American Urological Association guidelines for urolithiasis recommend the use of ureteral stents after surgery for urinary tract stones [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, no guidelines exist regarding postoperative urethral catheterization. Similarly, the Japanese Urological Association Guidelines for Urolithiasis (2022) do not specify whether a UC should be placed after URSL [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], resulting in variability in postoperative management among institutions.\u003c/p\u003e \u003cp\u003eTherefore, the safety and feasibility of omitting postoperative UC after URSL remains unclear. Accordingly, this study aimed to evaluate these aspects to address this gap in knowledge.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and population\u003c/h2\u003e \u003cp\u003eWe retrospectively reviewed data from 110 patients who underwent URSL for upper urinary tract stones at Kurume University Medical Center between June 2023 and September 2025. Patients who underwent procedures under spinal anesthesia (n\u0026thinsp;=\u0026thinsp;8) were excluded. Additionally, patients who underwent subsequent URSL for the same stone (n\u0026thinsp;=\u0026thinsp;14), underwent simultaneous surgery for bladder stones (n\u0026thinsp;=\u0026thinsp;5), had difficulty with postoperative pain assessment due to dementia or stroke (n\u0026thinsp;=\u0026thinsp;3), or had incomplete data (n\u0026thinsp;=\u0026thinsp;3) were further excluded. The remaining patients, all of whom underwent URSL under general anesthesia, were included in the final analysis. All surgeries were performed by a single experienced urologist to minimize inter-operator variability. Patients were divided into two groups according to postoperative UC placement: With-UC and Without-UC groups. UC placement was determined at the discretion of the primary surgeon, based on intraoperative findings and the patient\u0026rsquo;s condition. This study was approved by the Institutional Review Board of Kurume University Medical Center (Approval No. 2025-05). Opt-out consent was used in accordance with institutional policy.\u003c/p\u003e \u003cp\u003eThe following perioperative parameters were evaluated: age, sex, stone laterality, stone size, stone-free rate, operative time, total laser energy, postoperative hospital stay, postoperative pain assessed using a numeric rating scale (NRS), maximum hematuria grade, febrile UTI, and urinary retention.\u003c/p\u003e \u003cp\u003eStone size was defined as the largest diameter for solitary calculi, and as the sum of maximal diameters for multiple calculi. Volume was calculated as total stone burden using the formula: length \u0026times; width \u0026times; height \u0026times; 0.167\u0026thinsp;\u0026times;\u0026thinsp;π [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe severity of hematuria was graded on a 6-point visual scale according to the postoperative color of urine: Grade 0, clear urine; Grade 1, almost clear urine with only a faint pink tinge; Grade 2, light reddish urine; Grade 3, visibly red urine; Grade 4, dark red urine; and Grade 5, gross hematuria with a dark, almost black urine. These grades correspond to the approximate visual urine color intensity used in clinical assessments and have been routinely employed at our institution for postoperative evaluation. High-grade hematuria was defined as grade 3 or higher.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurgical procedure\u003c/h3\u003e\n\u003cp\u003eAll procedures were performed under general anesthesia. Semi-rigid ureteroscopy was performed using the Olympus WA2UR11A ureteroscope (Olympus, Tokyo, Japan), and flexible ureteroscopy was conducted using either the Olympus URF-P7 (Olympus, Tokyo, Japan) or the Boston Scientific LithoVue Elite (Boston Scientific, Marlborough, MA, USA). A ureteral access sheath was routinely used in all cases involving renal stones. The LithoVue Elite was preferentially selected for cases with large stone burdens (\u0026ge;\u0026thinsp;20 mm). Laser lithotripsy was performed using the Lumenis Pulse\u0026trade; 120H high-power holmium:YAG laser system (Lumenis, Yokneam, Israel). Energy settings ranged from 0.2 to 1.5 J with frequencies of 5 to 80 Hz. A 200-\u0026micro;m disposable laser fiber was used in most cases, while a reusable 200-\u0026micro;m fiber was occasionally used for small stones. Both dusting and fragmentation techniques were applied depending on stone characteristics. The dusting mode was defined as low energy and high frequency (\u0026lt;\u0026thinsp;1 J, \u0026ge; 20 Hz), whereas the fragmentation mode was defined as higher energy and lower frequency (\u0026ge;\u0026thinsp;0.8 J, \u0026le; 20 Hz). These techniques were applied using both laser fiber types. Postoperative ureteral stenting was routinely performed using either the Tria stent (Boston Scientific) or the Inlay Optima stent (Bard, Murray Hill, NJ, USA).\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables were compared using the Mann\u0026ndash;Whitney U test, and categorical variables were analyzed using Fisher\u0026rsquo;s exact test. Multivariate logistic regression analysis was performed to identify independent predictors of postoperative high-grade hematuria. Statistical significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05. All analyses were conducted using JMP Pro 18 software (SAS Institute, Cary, NC, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 77 patients met the inclusion criteria and were included in the final analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA total of 110 patients underwent ureteroscopic lithotripsy (URSL) during the study period. After excluding 33 patients, 77 patients were included in the final analysis, including 52 patients without postoperative urethral catheterization and 25 patients with postoperative urethral catheterization.\u003c/p\u003e \u003cp\u003eOf these, 52 (67.5%) were categorized into the Without-UC group and 25 (32.5%) into the With-UC group. Patients in the With-UC group were significantly older (median, 70 vs. 64 years; P\u0026thinsp;=\u0026thinsp;0.035) and had a higher number of stones (P\u0026thinsp;=\u0026thinsp;0.002) than those in the Without-UC group. No significant differences were observed between the groups regarding sex, comorbidities, and the size, location, and type of stones (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of patients undergoing ureteroscopic lithotripsy.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;77)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWithout UC (n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWith UC (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67 (58\u0026ndash;76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64 (57\u0026ndash;74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70 (61\u0026ndash;83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.035*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (46.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (48.1)\u003c/p\u003e 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\u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (4.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (8.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (46.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (52.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.522\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (12.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.748\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardiovascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.197\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOral anticoagulants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.263\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal stone volume (cm\u0026sup3;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.50 (0.25\u0026ndash;1.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.48 (0.18\u0026ndash;1.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.63 (0.31\u0026ndash;1.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.266\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCT attenuation (HU)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1180 (893\u0026ndash;1375)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1216 (881\u0026ndash;1375)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1102 (919\u0026ndash;1377)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.623\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStone location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eR2\u0026ndash;R3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (33.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (32.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.956\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eU1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (32.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (32.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eU2\u0026ndash;U3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (33.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (36.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of stones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (69.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (32.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (24.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (22.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (44.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStone composition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCalcium oxalate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (72.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (69.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.280\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCalcium phosphate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCarbonate Apatite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUric acid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eValues ​​are presented as numbers (%) or median (interquartile range).\u003c/p\u003e \u003cp\u003eBMI, body mass index; CT, computed tomography; HU, Hounsfield units; PS, performance status; UC, urethral catheter.\u003c/p\u003e \u003cp\u003eFurthermore, the operative time was significantly longer in the With-UC group (median: 94 min vs. 69 min; P\u0026thinsp;=\u0026thinsp;0.007). Total laser energy, complete stone clearance rate, postoperative hospitalization duration, and the incidence of febrile UTI or pain were comparable between the groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePerioperative outcomes according to postoperative urethral catheterization status.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;77)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWithout UC (n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWith UC (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of ureteroscope\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRigid only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (37.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (24.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRigid and flexible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (62.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (55.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (76.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (48\u0026ndash;104)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69 (35\u0026ndash;95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94 (66\u0026ndash;112)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.007*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal laser energy (kJ)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.63 (0.31\u0026ndash;7.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.34 (0.17\u0026ndash;7.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.20 (1.38\u0026ndash;9.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStone-free\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (82.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42 (82.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (84.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.858\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative hospital stays (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (2\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (2\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (3\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.649\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative febrile UTI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.320\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum hematuria grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (54.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (72.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.029*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (28.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (28.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecrease in hemoglobin (g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9 (0.4\u0026ndash;1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0 (0.4\u0026ndash;1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6 (0.4\u0026ndash;1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum postoperative NRS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (62.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (57.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (72.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.425\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (24.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (16.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (12.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of postoperative analgesics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (48.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (36.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.318\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of postoperative antiemetics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative urinary retention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.485\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative fall events\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eValues ​​are presented as numbers (%) or median (interquartile range).\u003c/p\u003e \u003cp\u003eUC, urethral catheter; NRS, numeric rating scale; UTI, urinary tract infection.\u003c/p\u003e \u003cp\u003eThe Without-UC group had a higher proportion of grade 3\u0026ndash;4 hematuria than the With-UC group (62.6% vs. 28.0%; P\u0026thinsp;=\u0026thinsp;0.029; Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eStacked bar charts show the relative frequency of postoperative hematuria grades in patients with and without postoperative urethral catheterization.\u003c/p\u003e \u003cp\u003eIn the multivariate logistic regression analysis, the absence of postoperative urethral catheterization (odds ratio, 3.606, 95% CI, 1.182\u0026ndash;12.365; P\u0026thinsp;=\u0026thinsp;0.024; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) was an independent risk factor for severe hematuria.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate logistic regression analysis of factors associated with high-grade postoperative hematuria.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRisk factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRisk category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eMultivariate analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOdds ratio (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOdds ratio (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.431 (0.168\u0026ndash;1.075)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.659 (0.238\u0026ndash;1.845)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.423\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.654 (0.667\u0026ndash;4.171)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral anticoagulants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.241 (0.509\u0026ndash;11.642)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior ureteral stent placement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.467 (0.156\u0026ndash;1.292)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStone location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKidney (R2\u0026ndash;R3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.973 (0.753\u0026ndash;5.298)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal stone volume (cm\u0026sup3;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.169 (0.469\u0026ndash;2.931)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.738\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCT attenuation (HU)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;1180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.063 (0.426\u0026ndash;2.660)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.896\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of stones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.604 (0.189\u0026ndash;1.805)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.371\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative UC placement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWithout\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.893 (1.064\u0026ndash;8.557)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.037*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.606 (1.182\u0026ndash;12.365)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.024*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative ureteral stent placement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.517 (0.066\u0026ndash;3.299)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.479\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of ureteroscope\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFlexible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.633 (0.245\u0026ndash;1.608)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.336\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.376 (0.952\u0026ndash;6.122)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.992 (1.068\u0026ndash;9.041)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.037*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal energy (kJ)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;1.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.417 (0.523\u0026ndash;3.902)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.493\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eureteral injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.606 (0.028\u0026ndash;6.595)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.682\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOdds ratios are presented with 95% confidence intervals.\u003c/p\u003e \u003cp\u003eUC, urethral catheter; OR, odds ratio; CI, confidence interval.\u003c/p\u003e \u003cp\u003eHowever, no significant difference was observed in the decrease in hemoglobin levels (median, 1.0 vs. 0.6 g/dL, P\u0026thinsp;=\u0026thinsp;0.208; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), suggesting that the hematuria was not clinically significant.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eUrethral catheterization is widely performed after URSL to prevent urinary retention, bladder discomfort, and hematuria. However, catheter placement has several potential disadvantages, including urethral trauma, urinary tract infection (UTI), allergic reactions to latex materials, and prolonged bed rest [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Additionally, it can lead to catheter-related bladder discomfort, which significantly affects postoperative comfort [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Although several clinical trials have investigated approaches to prevent postoperative catheter-related bladder discomfort [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], no standard management has been established, with the most effective preventive measure being omission of UC placement. Globally, more than 100\u0026nbsp;million catheters are used annually [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], unnecessary catheterization imposes environmental and financial burdens on healthcare systems. Efforts to reduce unnecessary UC use are crucial [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and routine UC placement after URSL should be reconsidered.\u003c/p\u003e \u003cp\u003eCurrent international clinical guidelines for the management of urinary stones lack clear recommendations for postoperative UC placement after URSL [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A similar approach is adopted in Japanese guidelines [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], where the decision is left at the discretion of individual institutions. Therefore, in clinical practice, postoperative management is often determined based on factors such as the type of anesthesia used and the patient\u0026rsquo;s background. As detrusor muscle contraction is completely suppressed under spinal anesthesia and partially suppressed by general anesthesia, postoperative urinary retention occurs more frequently after spinal anesthesia than after general anesthesia [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Herein, we only included patients who underwent URSL under general anesthesia. Consistently, postoperative urinary retention was observed in only one patient in the Without-UC group, which was attributed to a fear of painful urination rather than the anesthetic effect, confirming that the risk of urinary retention did not increase following omission of UC placement.\u003c/p\u003e \u003cp\u003eIn a large multicenter retrospective study involving 11,885 URSL procedures, intraoperative hematuria was reported in approximately 15% of cases; however, most of these cases were mild and clinically insignificant, requiring no intervention [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In the present study, none of the patients required bladder irrigation, blood transfusion, or other interventions for the management of hematuria. However, patients who did not undergo postoperative urethral catheterization had significantly higher hematuria grades than those who underwent catheter placement. Additionally, the omission of postoperative urethral catheterization and a longer operative time were identified as independent risk factors for postoperative hematuria. Herein, the hematuria was transient and most commonly observed at the time of first voiding. This may be attributed to urethral bleeding during spontaneous voiding and the absence of postoperative bladder irrigation. Importantly, the decrease in hemoglobin levels did not differ between the two groups, suggesting that the observed hematuria had limited clinical significance. Regarding postoperative management, the current findings do not contradict the safety of urethral catheterization omission in select cases. Collectively, these findings suggest that, in most cases, catheter placement can be omitted under careful postoperative observation.\u003c/p\u003e \u003cp\u003eHerein, patients in the With-UC group were significantly older, which likely reflects a tendency of clinicians to place urethral catheters more frequently in older patients with reduced activities of daily living (ADL) or a higher perceived risk of postoperative infection. Additionally, the number of stones was higher in the With-UC group, which may have indirectly influenced the decision regarding UC placement. As all procedures were performed by a single surgeon, this difference was not attributable to interoperator variation. Rather, patients with multiple stones tended to require longer operative times, which might have led to a greater concern for postoperative infection and, consequently, a higher rate of UC placement. However, in the multivariate analysis, the number of stones was not associated with postoperative complications, indicating that this factor had limited clinical relevance in the present context.\u003c/p\u003e \u003cp\u003eVery few studies have specifically examined the relationship between post-URSL UC placement and potential associated complications, such as febrile UTI, postoperative pain, or hematuria. Previous studies have identified older age, diabetes mellitus, prolonged operative time, positive preoperative urine culture, and postoperative ureteral stent placement as independent risk factors for febrile UTI after URSL [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Moreover, postoperative pain correlates with younger age and postoperative ureteral stent placement [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, none of these studies examined UC placement. In the present study, no significant differences were observed in postoperative pain, febrile UTI, or hospitalization duration between the groups.\u003c/p\u003e \u003cp\u003eIn a recent prospective randomized study comparing UC placement following ureteroscopic examination and JJ stent insertion, Sener et al. reported no significant difference in visual analog scale scores between groups; however, the \u0026ldquo;Total Body Pain\u0026rdquo; score on the Ureteric Stent Symptom Questionnaire was significantly lower in the catheterized group, suggesting a potential benefit of temporary postoperative catheterization in reducing overall pain perception [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In contrast, regarding URSL, Hori et al. conducted a retrospective analysis and demonstrated that the omission of urethral catheterization after URSL resulted in a lower incidence of febrile UTI in the non-catheterized group, supporting the safety of catheter-free postoperative management [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Likewise, Pawłowska-Krajka et al. performed a prospective trial involving patients who underwent URSL under spinal anesthesia and observed that postoperative pain was significantly milder in patients without UC placement [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCollectively, these findings indicate that urethral catheterization after URSL can be safely omitted in appropriate cases, and that selective rather than routine UC placement may improve postoperative comfort. The results of the present study are consistent with those of previous reports demonstrating that the omission of postoperative urethral catheterization does not increase the incidence of postoperative complications, such as fever, pain, or urinary retention, and can be managed safely. Overall, these results suggest that routine postoperative urethral catheterization after URSL performed under general anesthesia may not be necessary, and its omission can be considered in select cases.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, this is a retrospective, single-center analysis with a relatively small sample size, which may limit the generalizability of the findings. Second, although all surgeries were performed by a single experienced urologist, which reduced operator-related bias, differences in patient background between the groups may have influenced the outcomes. Third, postoperative pain was assessed using a general NRS that did not specifically reflect catheter-related discomfort. Finally, hematuria grades were visually assessed by the nursing staff, which may have introduced observer variability. Despite these limitations, this study provides novel insights, focusing exclusively on URSL performed under general anesthesia, which have rarely been reported. Further multicenter prospective studies are warranted to corroborate these findings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNI: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing\u0026ndash;original draft preparation. SS: Supervision, Validation, Writing\u0026ndash;review \u0026amp; editing. TI: Supervision, Project administration, Writing\u0026ndash;review \u0026amp; editing. All authors reviewed and approved the final version of the manuscript prior to submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to institutional policies and patient privacy regulations but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board of Kurume University Medical Center (IRB No. 2025-05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOpt-out consent was used in accordance with institutional policy.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSkolarikos A, Geraghty R, Samani B, Tailly T, Jung H, Neisius A et al (2025) European Association of Urology Guidelines on the Diagnosis and Treatment of Urolithiasis. Eur Urol 88(1):64\u0026ndash;75\u003c/li\u003e\n\u003cli\u003eAssimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP et al (2016) Surgical management of stones: American Urological Association/Endourological Society guideline, part II. J Urol 196(4):1161\u0026ndash;1169\u003c/li\u003e\n\u003cli\u003eDellimore KH, Helyer AR, Franklin SE (2013) A scoping review of important urinary catheter induced complications. J Mater Sci Mater Med 24(8):1825\u0026ndash;1835\u003c/li\u003e\n\u003cli\u003eMiyazawa K, Yamaguchi S, Iguchi T, Chikazawa I, Yasui T, Takahashi S et al (2025) Summary of the clinical practice guideline for the management of urinary stones, third edition. Int J Urol 32(5):462\u0026ndash;474\u003c/li\u003e\n\u003cli\u003ePanthier F, Kutchukian S, Ducousso H, Doizi S, Solano C, Candela L et al (2024) How to estimate stone volume and its use in stone surgery: a comprehensive review. Actas Urol Esp (Engl Ed) 48(1):71\u0026ndash;78\u003c/li\u003e\n\u003cli\u003eNollen JM, Pijnappel L, Schoones JW, Peul WC, Van Furth WR, Brunsveld-Reinders AH (2023) Impact of early postoperative indwelling urinary catheter removal: a systematic review. J Clin Nurs 32(9\u0026ndash;10):2155\u0026ndash;2177\u003c/li\u003e\n\u003cli\u003eBai Y, Wang X, Li X, Pu C, Yuan H, Tang Y et al (2015) Management of catheter-related bladder discomfort in patients who underwent elective surgery. J Endourol 29(6):640\u0026ndash;649\u003c/li\u003e\n\u003cli\u003eWang Z, Li H, Wang Y, Li Y, Li L, Zhang L et al (2025) Esketamine for preventing catheter-related bladder discomfort after ureteroscopic lithotripsy: A randomized controlled trial. BMC Anesthesiol 25(1):361\u003c/li\u003e\n\u003cli\u003eAgarwal A, Dhiraaj S, Singhal V, Kapoor R, Tandon M (2006) Comparison of efficacy of oxybutynin and tolterodine for prevention of catheter related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study. Br J Anaesth 96(3):377\u0026ndash;380\u003c/li\u003e\n\u003cli\u003eCameron AP, Werneburg GT (2025) Foley catheter management: a review. JAMA Surg 160(6):701\u0026ndash;707\u003c/li\u003e\n\u003cli\u003eFakih MG, Watson SR, Greene MT, Kennedy EH, Olmsted RN, Krein SL et al (2012) Reducing inappropriate urinary catheter use: a statewide effort. Arch Intern Med 172(3):255\u0026ndash;260 \u003c/li\u003e\n\u003cli\u003eBaldini G, Bagry H, Aprikian A, Carli F (2009) Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology 110(5):1139\u0026ndash;1157\u003c/li\u003e\n\u003cli\u003ePavlin DJ, Pavlin EG, Gunn HC, Taraday JK, Koerschgen ME (1999) Voiding in patients managed with or without bladder catheterization during outpatient surgery. Anesth Analg 88:581\u0026ndash;585\u003c/li\u003e\n\u003cli\u003eTanriverdi O, Silay MS, Kadihasanoglu M, Aydin M, Kendirci M, Miroglu C (2012) Revisiting the predictive factors for intra-operative complications of rigid ureteroscopy: a 15-year experience. Urol J 9(2):457\u0026ndash;464\u003c/li\u003e\n\u003cli\u003eBhojani N, Miller LE, Bhattacharyya S, Cutone B, Chew BH (2021) Risk factors for urosepsis after ureteroscopy for stone disease: A systematic review with meta-analysis. J Endourol 35(7):991\u0026ndash;1000\u003c/li\u003e\n\u003cli\u003ePengfei S, Yutao L, Jie Y, Wuran W, Yi D, Hao Z et al (2011) The results of ureteral stenting after ureteroscopic lithotripsy for ureteral calculi: a systematic review and meta-analysis. J Urol 186(5):1904\u0026ndash;1909\u003c/li\u003e\n\u003cli\u003eGul Z, Alazem K, Li I, Monga M (2016) Predicting procedural pain after ureteroscopy: does hydrodistention play a role? Int. Braz. J Urol 42(4):734\u0026ndash;739\u003c/li\u003e\n\u003cli\u003eSener TE, Ozgur G, Cetin M, Pietropaolo A, Tzelves L, Esperto F et al (2025) Foley catheter after ureteroscopy and JJ stent placement: a randomised prospective European Association of Urology Section of Urolithiasis-Young Academic Urologists (EULIS-YAU) endourology study. BJU Int 135(1):95\u0026ndash;102\u003c/li\u003e\n\u003cli\u003eHori S, Otsuki H, Fujio K, Nakajima K, Mitsui Y (2022) Impact of eliminating urethral catheterization following ureterorenoscopic lithotripsy. Int. J. Urol 29(4):337\u0026ndash;342\u003c/li\u003e\n\u003cli\u003ePawłowska-Krajka E, Dorobek A (2017) The impact of urinary bladder catheterisation after ureterorenoscopic stone removal on the postoperative course. Cent European J Urol 70(4):405\u0026ndash;411\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"general anesthesia, hematuria, postoperative management, ureteroscopic lithotripsy, urethral catheter","lastPublishedDoi":"10.21203/rs.3.rs-8571812/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8571812/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWe evaluated the safety and feasibility of omitting postoperative urethral catheterization after ureteroscopic lithotripsy under general anesthesia. Data from 77 patients who underwent ureteroscopic lithotripsy for upper urinary tract stones between June 2023 and September 2025 were retrospectively reviewed and categorized according to postoperative urethral catheter placement. Perioperative outcomes, including postoperative pain, hematuria, febrile urinary tract infection, and urinary retention, were compared between the groups, and multivariate logistic regression analysis was performed to identify independent predictors of postoperative complications. Patients who underwent postoperative catheterization were significantly older and had longer operative times than those without catheterization. Absence of postoperative urethral catheterization was independently associated with a higher risk of high-grade hematuria; however, the hematuria was transient and clinically insignificant. No significant differences were observed in postoperative pain, febrile urinary tract infection, or urinary retention. These findings indicate that omission of postoperative urethral catheterization after ureteroscopic lithotripsy under general anesthesia is generally safe and does not increase the risk of infection or urinary retention. Routine catheterization appears unnecessary, and selective use may be sufficient in clinical practice.\u003c/p\u003e","manuscriptTitle":"Safety of omitting postoperative urethral catheterization after ureteroscopic lithotripsy under general anesthesia: A single-center retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-20 10:52:56","doi":"10.21203/rs.3.rs-8571812/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"080f9211-ac5e-46d3-a862-f28f57c626c4","owner":[],"postedDate":"January 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-19T21:54:08+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-20 10:52:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8571812","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8571812","identity":"rs-8571812","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}