Early Stent Removal via Tie-on-Foley Fixation versus Conventional JJ Stenting after Ureteroscopic Lithotripsy: A Retrospective Comparative Study

Early Stent Removal via Tie-on-Foley Fixation versus Conventional JJ Stenting after Ureteroscopic Lithotripsy: A Retrospective Comparative 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 Early Stent Removal via Tie-on-Foley Fixation versus Conventional JJ Stenting after Ureteroscopic Lithotripsy: A Retrospective Comparative Study Po-Wen Wu, Pin-Jui Chen, Huan-Kai Wang, Wen-Hsin Tseng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8261668/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 Background To compare outcomes between early stent removal using tie-on-Foley fixation and conventional double-J stenting after ureteroscopic lithotripsy. Methods This retrospective study included 262 patients treated between January 2022 and December 2024. Patients were assigned to either the tie-on-Foley group (n = 58), with stent and Foley removed together on postoperative day 2, or the conventional group (n = 204), with stent removal after 2–4 weeks. Outcomes included operative time, pain scores, stone-free rates, and complications. Results The tie-on-Foley group demonstrated significantly shorter mean operative times. While the tie-on-Foley group reported higher visual analogue scale scores at removal (4.06 versus 2.03, p < 0.001) and required more short-term opioids, they experienced significantly fewer overall postoperative complications (10.3% versus 23.0%, p = 0.034). Notably, postoperative fever was observed exclusively in the conventional group (8.3% versus 0%, p = 0.023). Stone-free rates at one month were comparable between groups. Conclusion Early stent removal via tie-on-Foley fixation is a safe strategy for selected patients with small, distal ureteral calculi and low infection risk. While it causes transient discomfort during removal, it is associated with fewer overall complications and avoids the morbidity of prolonged stenting without compromising surgical success. Clinical trial number Not applicable. Trial registration Not applicable. Ureteroscopic lithotripsy Ureteral calculi Ureteral stent Postoperative complications Early stent removal Background Urolithiasis is a prevalent and recurrent urological disease in Taiwan, with a national prevalence of 7.38% and a 5-year recurrence rate of 34.7%. Ureteral stones account for approximately 76.4% of stone-related hospitalizations, underscoring the substantial clinical and economic burden of this condition[ 1 , 2 ]. Advances in endourology have expanded treatment options, including medical expulsive therapy, shock wave lithotripsy (SWL), ureteroscopic lithotripsy (URSL), percutaneous nephrolithotomy (PCNL), and, in selected cases, laparoscopic ureterolithotomy (LU)[ 3 ]. URSL is now the preferred intervention for impacted ureteral calculi—particularly for stones > 10 mm or after failed SWL—because it provides high stone-free rates with low retreatment requirements and minimal invasiveness[ 3 – 5 ]. For complex or refractory proximal stones, PCNL or LU may be pursued as alternative approaches[ 6 , 7 ]. Despite its efficacy, URSL remains technically demanding and may result in mucosal or thermal injury, ureteral edema, infection, or postoperative stricture formation[ 3 , 8 ]. Postoperative management following URSL, especially the decision to place a ureteral stent and determine its duration, continues to be debated. Conventionally, a double-J (JJ) stent is inserted to prevent obstruction from postoperative edema and to reduce the risk of infection or stricture, and it is typically retained for 2–4 weeks [ 3 , 9 ]. However, JJ stents frequently cause bothersome lower urinary tract symptoms—reported in up to 32.7% of patients—including urgency, frequency, hematuria, and suprapubic discomfort, often necessitating unscheduled medical consultations[ 9 , 10 ]. Prolonged stent indwelling further increases the risk of urinary tract infections (14.8%), obstruction (1.9%), malposition (0.3%), and a measurable decline in quality of life[ 10 , 11 ]. Given these concerns, recent work has explored selective or short-term stenting strategies. Findings suggest that selected patients may achieve comparable postoperative outcomes with shorter stent dwell times, thereby reducing morbidity associated with prolonged stenting[ 9 , 11 – 13 ]. However, evidence directly comparing early stent removal using tie-on-Foley fixation with conventional JJ stenting—particularly in non-pre-stented patients—remains limited. Addressing this gap may help streamline postoperative care and enhance patient recovery. Therefore, the present retrospective study compared postoperative outcomes and complications between conventional JJ stenting and short-term tie-on-Foley stent removal following URSL for ureteral calculi. This comparison aims to inform optimal stent management practices and promote patient-centered postoperative care. Materials and Methods Study Design and Patient Selection This retrospective observational study was conducted at Chi Mei Medical Center from January 2022 to December 2024. All URSL procedures for ureteral calculi were performed by a single experienced urologist (Dr. Tseng) to ensure uniformity in surgical technique and perioperative care. A total of 471 consecutive patients who underwent URSL during the study period were screened. Patients were excluded if they underwent concomitant procedures (e.g., PCNL, transurethral resection of the prostate), had congenital or acquired urinary tract abnormalities, underwent laser lithotripsy rather than pneumatic lithotripsy, had a history of urothelial malignancy, did not receive postoperative ureteral stenting, or had incomplete clinical or follow-up data. After applying these criteria, 262 patients were eligible and included in the final analysis. Surgical Technique and Postoperative Management Patients were assigned to one of two groups based on the postoperative ureteral stent management strategy. In the tie-on-Foley group, the distal end of the ureteral stent was secured to the Foley catheter at the conclusion of the procedure. The Foley catheter was removed on postoperative day (POD) 2, and patients were discharged the following day if no significant discomfort was reported. In the conventional group, the ureteral stent was placed without attachment to the Foley catheter. These patients had their Foley catheter removed on POD 1 and were discharged the same day once spontaneous voiding occurred without discomfort. The JJ stent was scheduled for removal 2–4 weeks postoperatively. The choice between tie-on-Foley fixation and conventional indwelling stenting was made intraoperatively at the surgeon's discretion, based on intraoperative findings and the patient’s overall clinical status. Outcome Assessment and Statistical Analysis Postoperative outcomes were assessed using several clinical and procedural parameters, including operative time, length of hospital stay, postoperative pain measured using the visual analogue scale (VAS), and stone-free status confirmed by imaging at one month postoperatively. Stent-related complications, as well as unplanned emergency department (ED) visits or hospital readmissions within three months of surgery, were also recorded. Continuous variables were compared between groups using either the independent-samples t-test or the Mann–Whitney U test, depending on distributional characteristics. Categorical variables were analyzed using the chi-square test or Fisher's exact test, as appropriate. To identify predictors of postoperative complications, univariate logistic regression analyses were first conducted for all clinical variables. Variables with a p value < 0.10 in univariate analyses were included in a multivariable model to determine independent predictors. Results are reported as odds ratios (ORs) with corresponding 95% confidence intervals (CIs). A two-tailed p value < 0.05 was considered statistically significant. Results A total of 262 patients who underwent URSL were included in the study, comprising 58 patients in the tie-on-Foley group and 204 in the conventional stent group. Baseline demographic and clinical characteristics were largely comparable between groups (Table 1 ), with no significant differences in age, sex, body mass index (BMI), comorbidities, renal function, or stone laterality. However, significant variations were observed in stone characteristics and infection parameters. The tie-on-Foley group had a higher proportion of lower ureteral stones and smaller mean stone size compared with the conventional group (0.62 ± 0.33 cm vs. 0.75 ± 0.39 cm, p = 0.022), whereas upper ureteric or ureteropelvic junction (UPJ) stones were more common in the conventional group ( p = 0.006). Preoperative pyuria was also more prevalent in the conventional group (57.7% vs. 37.5%, p = 0.008). Operative and postoperative outcomes are summarized in Table 2 . The mean operative time was significantly shorter in the tie-on-Foley group than in the conventional group (22.9 ± 12.7 min vs. 28.3 ± 18.7 min, p = 0.012). While hospital stay and the rate of outpatient surgery were comparable between groups, postoperative pain outcomes differed substantially. The tie-on-Foley group reported significantly higher VAS pain scores (4.06 ± 2.64 vs. 2.03 ± 2.25, p < 0.001), reflecting discomfort associated with simultaneous removal of the Foley catheter and ureteral stent. Correspondingly, short-term opioid use was more frequent in this group (37.9% vs. 15.7%, p < 0.001), followed by acetaminophen at discharge, whereas nearly all patients in the conventional group required postoperative nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control (97.5% vs. 56.9%, p = 0.009). Despite higher pain scores in the tie-on-Foley group, postoperative complications occurred significantly less often than in the conventional group (10.3% vs. 23.0%, p = 0.034). Postoperative fever was observed exclusively in the conventional group (8.3% vs. 0%, p = 0.023), potentially reflecting the longer indwelling duration of the JJ stent. Rates of gross hematuria, unplanned ED visits, and hospital readmissions were slightly higher in the conventional group, although these differences were not statistically significant. Postoperative renal function and stone-free rates at one month were comparable between the two groups. Risk factors associated with postoperative complications were further analyzed using logistic regression (Table 3 ). Increased BMI (OR = 1.10, p = 0.041), dyslipidemia (OR = 6.78, p = 0.004), and stone location (OR = 0.68, p = 0.023) were identified as independent predictors of complications. Patients with lower ureteral or ureterovesical junction stones had a lower risk of developing complications compared with those with upper ureteric or UPJ stones. The presence of a conventional JJ stent (OR = 2.67, p = 0.087) and preoperative pyuria (OR = 2.06, p = 0.090) showed a trend toward increased complication risk, although these associations did not reach statistical significance. Table 1 Demographic and clinical profile Tie-on-Foley group (n = 58) Conventional group (n = 204) p value Age, years (mean ± SD) 53.3 ± 15.8 53.6 ± 14.4 0.882 Sex, n (%) 0.471 Male 38 (65.5%) 123 (60.3%) Female 20 (34.5%) 81 (39.7%) BMI, kg/m 2 (mean ± SD) 25.2 ± 4.2 26.1 ± 4.5 0.167 Systemic disease, n (%) 23 (39.7%) 87 (42.6%) 0.166 Creatinine, mg/dL (mean ± SD) 1.03 ± 0.26 1.21 ± 0.88 0.132 History of urolithiasis, n (%) 28 (48.3%) 74 (36.3%) 0.098 Side, n (%) 0.895 Right 29 (50%) 100 (49.0%) Left 29 (50%) 104 (51.0%) Stone location, n (%) 0.006* UPJ 0 (0%) 10 (4.9%) Upper third ureter 19 (32.8%) 104 (51.0%) Middle third ureter 4 (6.9%) 21 (10.3%) Lower third ureter 26 (44.8%) 51 (25.0%) UVJ 9 (15.5%) 18 (8.8%) Stone size, cm (mean ± SD) 0.62 ± 0.33 0.75 ± 0.39 0.022* Hounsfield unit (mean ± SD) 605.1 ± 367.7 608.4 ± 381.2 0.958 Hydronephrosis, n (%) 47 (90.4%) 186 (91.2%) 0.078 Preoperative pyuria, n (%) 21 (37.5%) 113 (57.7%) 0.008* BMI: Body mass index, UPJ: Ureteropelvic junction, UVJ: Ureterovesical junction *: p < 0.05, statistically significant Table 2 Operative and postoperative outcomes Tie-on-Foley group (n = 58) Conventional group (n = 204) p value Operative time, mins (mean ± SD) 22.88 ± 12.69 28.29 ± 18.72 0.012* OPD surgery, n (%) 18 (31%) 54 (26.5%) 0.492 Hospitalization, days (mean ± SD) 2.24 ± 1.91 2.76 ± 2.74 0.174 VAS score (mean ± SD) 4.06 ± 2.64 2.03 ± 2.25 < 0.001* Use of NSAIDs, n (%) 33 (56.9%) 199 (97.5%) 0.009* Use of Opioid, n (%) 22 (37.9%) 32 (15.7%) < 0.001* Use of Tranexamic acid, n (%) 6 (10.3%) 38 (18.6%) 0.136 Complications, n (%) 6 (10.3%) 47 (23.0%) 0.034* Fever, n (%) 0 (0%) 17 (8.3%) 0.023* Gross hematuria, n (%) 6 (10.3%) 17 (8.3%) 0.633 Emergency visit rate, n (%) 4 (6.9%) 26 (12.7%) 0.217 Readmission, n (%) 1 (1.7%) 7 (3.4%) 0.502 Postoperative creatinine, mg/dL (mean ± SD) 0.95 ± 0.25 0.98 ± 0.40 0.745 SFR, n (%) 58 (100%) 197 (96.6%) 0.208 OPD: Outpatient department, VAS: Visual analog scale, NSAIDs: Non-steroidal anti-inflammatory drugs, SFR: Stone-free rate *: p < 0.05, statistically significant Table 3 Logistic regression analyses for predictors of postoperative complications Logistic regression Odds Ratio (95% CI) p value Age 1.02 (0.99–1.06) 0.140 BMI 1.10 (1.00–1.21) 0.041 * Preoperative creatinine 0.84 (0.54–1.31) 0.437 Conventional group 2.67 (0.87–8.24) 0.087 a Stone location 0.68 (0.48–0.95) 0.023 * Stone size 1.35 (0.36–4.97) 0.657 Systemic disease 0.74 (0.15–3.62) 0.706 Diabetes mellitus 0.70 (0.20–2.46) 0.583 Hypertension 0.53 (0.13–2.13) 0.373 Dyslipidemia 6.78 (1.81–25.35) 0.004 * Degree of hydronephrosis 1.21 (0.77–1.89) 0.411 Preoperative pyuria 2.06 (0.89–4.77) 0.090 a BMI: Body mass index, UPJ: Ureteropelvic junction, UVJ: Ureterovesical junction *: p < 0.05, statistically significant a: Showed a trend toward increased risk but did not reach statistical significance Discussion This retrospective observational study compared two postoperative ureteral stent management strategies following URSL: the tie-on-Foley approach, which allowed early removal on POD 2, and the conventional JJ stent approach, with outpatient removal 2–4 weeks postoperatively. Our results demonstrated comparable stone-free rates and overall postoperative outcomes between the two groups, while the tie-on-Foley approach offered additional advantages, including shorter drainage duration and fewer stent-related symptoms (SRS). These findings suggest that tie-on-Foley drainage may be a feasible and safe alternative to conventional stenting in selected patients undergoing uncomplicated URSL. Routine ureteral stenting after URSL has traditionally been recommended to prevent postoperative obstruction, ureteral edema, and hydronephrosis[ 3 , 9 , 14 , 15 ]. However, recent studies indicate that omission or early removal of ureteral stents after uncomplicated URSL reduces SRS—such as dysuria, frequency, urgency, and pain—while improving short-term quality of life, without compromising stone clearance or increasing major adverse outcomes[ 9 , 13 , 16 , 17 ]. In our series, the tie-on-Foley group, functioning as short-term external drainage, exhibited a significantly lower overall complication rate compared with the conventional group (10.3% vs. 23.0%, p = 0.034) and no incidence of postoperative fever (0% vs. 8.3%, p = 0.023). There were no significant differences in stone-free rates, emergency visits, or unplanned readmissions. These observations align with prior studies showing that minimizing stent indwelling time reduces SRS and improves patient-reported outcomes without increasing procedure-related complications[ 16 – 18 ]. It is important to note that the conventional group had a significantly higher prevalence of preoperative pyuria (57.7% vs. 37.5%, p = 0.008), which likely contributed to the higher febrile rate. However, our findings robustly demonstrate that for patients with relatively clean urine and uncomplicated stones, early stent removal via the tie-on-Foley technique does not increase the risk of postoperative infection, affirming its safety in this specific population. Postoperative pain patterns differed between groups. Patients in the tie-on-Foley group reported higher mean VAS scores (4.06 ± 2.64 vs. 2.03 ± 2.25, p < 0.001), likely due to transient bladder discomfort associated with simultaneous removal of the Foley catheter and stent on POD 2. Consequently, these patients required more short-term opioid analgesics (37.9% vs. 15.7%, p < 0.001). In contrast, patients in the conventional group relied more on NSAIDs for both febrile events and ongoing symptom control (97.5% vs. 56.9%, p = 0.009), consistent with previous findings that prolonged JJ stent placement contributes to persistent irritative symptoms and discomfort[ 16 – 18 ]. Similar mechanisms—such as trigonal irritation and vesicoureteral reflux caused by the distal stent coil—have been proposed to explain stent-related discomfort[ 19 , 20 ]. Several pharmacologic strategies can alleviate these symptoms. For example, α-blockers reduce bladder irritation and smooth muscle spasm, while NSAIDs serve as adjuncts to decrease ureteral contractility and improve pain control, often functioning as opioid-sparing agents[ 19 , 21 ]. Although these approaches can mitigate discomfort, they do not completely eliminate SRS[ 19 ]. Nevertheless, pharmacologic therapy remains valuable for improving patient quality of life prior to stent removal[ 21 ]. In multivariable analysis, higher BMI (OR = 1.10, p = 0.041) and dyslipidemia (OR = 6.78, p = 0.004) emerged as independent predictors of postoperative complications (Table 3 ). Both factors have been previously associated with increased stone burden[ 22 , 23 ]. However, the finding regarding dyslipidemia warrants cautious interpretation. The wide confidence interval (1.81–25.35) suggests statistical instability may be due to limited event outcomes rather than a direct pathophysiological link. Elevated BMI has also been linked to higher retreatment rates, greater postoperative complications, and lower stone-free rates, potentially predisposing patients to infection or delayed recovery[ 24 ]. Additionally, preoperative pyuria demonstrated a trend toward increased complication risk (OR = 2.06, p = 0.09), consistent with prior reports linking positive urine cultures to febrile events and urinary tract infections following URSL[ 25 ]. Liu et al. reported that JJ stent removal using an extraction string—a method conceptually similar to the tie-on-Foley approach—offers multiple benefits[ 26 ]. This technique avoids secondary cystoscopic removal, ensures safe drainage, and may reduce healthcare costs and patient anxiety without increasing the risk of urinary tract infection, emergency visits, dislodgement, or other complications[ 26 – 29 ]. Given the significant impact of SRS on quality of life[ 18 ], short-term drainage via tie-on-Foley stents may represent a pragmatic compromise between clinical efficacy and patient comfort. Overall, these findings suggest that tie-on-Foley stent removal can facilitate smoother postoperative recovery by minimizing stent-related discomfort and reducing analgesic requirements, particularly in patients with small, distal ureteral stones. This strategy achieves a practical balance between adequate urinary drainage and patient-centered comfort. Several limitations should be acknowledged. First, this was a single-center study performed by a single surgeon, which may limit generalizability but ensured procedural consistency. Second, baseline differences existed between groups, particularly in stone location and size (Table 1 ), reflecting inherent selection bias. Patients with smaller, distal stones were more likely to receive tie-on-Foley drainage, based on surgeon assessment. These disparities may have influenced operative time—which was longer in the conventional group (28.29 ± 18.72 min vs. 22.88 ± 12.69 min, p = 0.012)—as well as postoperative outcomes, and thus the lower complication rate observed in the tie-on-Foley cohort may partly reflect underlying case complexity rather than the drainage method alone. Third, postoperative discomfort was recorded from clinical notes rather than using validated instruments such as the Ureteral Stent Symptom Questionnaire[ 30 ]. Lastly, the marked sample size disparity between the tie-on-Foley group (n = 58) and the conventional group (n = 204), along with the low number of complications, may have introduced bias or reduced statistical stability. For instance, the high odds ratio for dyslipidemia, accompanied by a wide confidence interval, may reflect these limitations and should be interpreted with caution. Future randomized controlled trials incorporating standardized symptom scoring are warranted to clarify the true benefits of the tie-on-Foley approach and to establish optimal patient selection criteria. Conclusion In this retrospective study comparing ureteral stent management strategies following URSL, both tie-on-Foley and conventional approaches achieved comparable stone-free rates and postoperative renal function. Although patients in the tie-on-Foley group experienced transient discomfort at stent removal, this was effectively managed with short-term opioid use and simple analgesics after discharge. In contrast, the conventional group demonstrated higher rates of postoperative complications and febrile episodes, along with greater reliance on NSAID-based analgesia. These findings indicate that early stent removal via Foley catheter fixation is a feasible and safe alternative to conventional stenting, particularly for patients with smaller, distal ureteral stones. This approach may reduce SRS, shorten the duration of discomfort, decrease analgesic requirements, and potentially lower healthcare costs, without compromising surgical outcomes. Multicenter randomized trials are warranted to validate these results and to identify patient populations most likely to benefit from this simplified drainage strategy. Abbreviations BMI Body mass index CI Confidence interval ED Emergency department JJ stent/ DJ stent Double-J ureteral stent LU Laparoscopic ureterolithotomy NSAID Non-steroidal anti-inflammatory drug OPD Outpatient department OR Odds ratio PCNL Percutaneous nephrolithotomy POD Postoperative day SD Standard deviation SFR Stone-free rate SRS Stent-related symptoms SWL Shock wave lithotripsy UPJ Ureteropelvic junction URSL Ureteroscopic lithotripsy UVJ Ureterovesical junction VAS Visual analogue scale Declarations Ethics approval and consent to participate This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of Chi Mei Medical Center (Date: 2025/11/15 / No.: T-38284). Informed consent was waived due to the retrospective nature of the study. All patient data were de-identified and analyzed anonymously to ensure confidentiality. Consent for publication Not applicable Competing Interests The authors declare that they have no competing interests. Funding No funding was received for this study. Author Contribution WHT conceived and designed the study and critically revised the manuscript. PWW and PJC were responsible for data collection. PWW, HKW and PJC performed the data analysis and drafted the manuscript. WHT and HKW served as co-corresponding authors. All authors read and approved the final manuscript. Acknowledgement The authors extend their appreciation to the Department of Urology at Chi Mei Medical Center for their support in facilitating this study. Data Availability The datasets used and analysed during the current study are available from the corresponding author on reasonable request. References Huang WY, Chen YF, Carter S, Chang HC, Lan CF, Huang KH. Epidemiology of upper urinary tract stone disease in a Taiwanese population: a nationwide, population based study. 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BJU Int. 2014;113(4):605–9. http://doi.org/10.1111/bju.12541 . Luo Z, Jiao B, Zhao H, Huang T, Geng L, Zhang G. The Efficacy and Safety of Ureteric Stent Removal with Strings versus No Strings: Which Is Better? Biomed Res Int. 2020;2020:4081409. http://doi.org/10.1155/2020/4081409 . Harrison NL, Hughes C, Somani BK. Is Stent on a String the New Gold Standard for Postureteroscopy Ureteral Drainage? Evidence from a Systematic Review. J Endourol. 2024;38(2):159–69. http://doi.org/10.1089/end.2023.0412 . Joshi HB, Newns N, Stainthorpe A, MacDonagh RP, Keeley FX Jr., Timoney AG. Ureteral stent symptom questionnaire: development and validation of a multidimensional quality of life measure. J Urol. 2003;169(3):1060–4. http://doi.org/10.1097/01.ju.0000049198.53424.1d . Additional Declarations No competing interests reported. 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Pin-Jui","middleName":"","lastName":"Chen","suffix":""},{"id":571247571,"identity":"b216dbb8-0306-4377-aada-41c622df0d19","order_by":2,"name":"Huan-Kai Wang","email":"","orcid":"","institution":"Chi Mei Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Huan-Kai","middleName":"","lastName":"Wang","suffix":""},{"id":571247572,"identity":"3c6b98b0-3b35-4007-a439-bdce27062f4b","order_by":3,"name":"Wen-Hsin Tseng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvElEQVRIiWNgGAWjYNCCCgYGA6IV84DJM0haeIjSwthGihZ7Bh7Dx4XzDsubszcfYPhRsY3BXiKBkC08xsYztx023NlzLIGx58xtBh7CWni3SfNuO8y44UaOATNjG1CLNGEt23/zzjlsT5KWbcy8DYcTSdBymP+zNM+x9OQNZ44lHAT6hYfn/gP8Wtjb2xI/89RY22443nzwwY+K23LsPQfwa2FgBpPNYPIAAxHRAgN1xCocBaNgFIyCkQgAW3A+PPpokAkAAAAASUVORK5CYII=","orcid":"","institution":"Chi Mei Medical 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10:09:35","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":115914,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8261668/v1/f3106157f3f9273837579b6a.html"},{"id":100876517,"identity":"c4d6d2a0-35da-4b2a-90b0-71277b3311e0","added_by":"auto","created_at":"2026-01-22 10:25:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":742594,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8261668/v1/3245e674-5bda-4c72-8c25-8a02cfc96c99.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Early Stent Removal via Tie-on-Foley Fixation versus Conventional JJ Stenting after Ureteroscopic Lithotripsy: A Retrospective Comparative Study","fulltext":[{"header":"Background","content":"\u003cp\u003eUrolithiasis is a prevalent and recurrent urological disease in Taiwan, with a national prevalence of 7.38% and a 5-year recurrence rate of 34.7%. Ureteral stones account for approximately 76.4% of stone-related hospitalizations, underscoring the substantial clinical and economic burden of this condition[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Advances in endourology have expanded treatment options, including medical expulsive therapy, shock wave lithotripsy (SWL), ureteroscopic lithotripsy (URSL), percutaneous nephrolithotomy (PCNL), and, in selected cases, laparoscopic ureterolithotomy (LU)[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. URSL is now the preferred intervention for impacted ureteral calculi\u0026mdash;particularly for stones\u0026thinsp;\u0026gt;\u0026thinsp;10 mm or after failed SWL\u0026mdash;because it provides high stone-free rates with low retreatment requirements and minimal invasiveness[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. For complex or refractory proximal stones, PCNL or LU may be pursued as alternative approaches[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Despite its efficacy, URSL remains technically demanding and may result in mucosal or thermal injury, ureteral edema, infection, or postoperative stricture formation[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePostoperative management following URSL, especially the decision to place a ureteral stent and determine its duration, continues to be debated. Conventionally, a double-J (JJ) stent is inserted to prevent obstruction from postoperative edema and to reduce the risk of infection or stricture, and it is typically retained for 2\u0026ndash;4 weeks [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, JJ stents frequently cause bothersome lower urinary tract symptoms\u0026mdash;reported in up to 32.7% of patients\u0026mdash;including urgency, frequency, hematuria, and suprapubic discomfort, often necessitating unscheduled medical consultations[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Prolonged stent indwelling further increases the risk of urinary tract infections (14.8%), obstruction (1.9%), malposition (0.3%), and a measurable decline in quality of life[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven these concerns, recent work has explored selective or short-term stenting strategies. Findings suggest that selected patients may achieve comparable postoperative outcomes with shorter stent dwell times, thereby reducing morbidity associated with prolonged stenting[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, evidence directly comparing early stent removal using tie-on-Foley fixation with conventional JJ stenting\u0026mdash;particularly in non-pre-stented patients\u0026mdash;remains limited. Addressing this gap may help streamline postoperative care and enhance patient recovery.\u003c/p\u003e \u003cp\u003eTherefore, the present retrospective study compared postoperative outcomes and complications between conventional JJ stenting and short-term tie-on-Foley stent removal following URSL for ureteral calculi. This comparison aims to inform optimal stent management practices and promote patient-centered postoperative care.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Patient Selection\u003c/h2\u003e \u003cp\u003eThis retrospective observational study was conducted at Chi Mei Medical Center from January 2022 to December 2024. All URSL procedures for ureteral calculi were performed by a single experienced urologist (Dr. Tseng) to ensure uniformity in surgical technique and perioperative care.\u003c/p\u003e \u003cp\u003eA total of 471 consecutive patients who underwent URSL during the study period were screened. Patients were excluded if they underwent concomitant procedures (e.g., PCNL, transurethral resection of the prostate), had congenital or acquired urinary tract abnormalities, underwent laser lithotripsy rather than pneumatic lithotripsy, had a history of urothelial malignancy, did not receive postoperative ureteral stenting, or had incomplete clinical or follow-up data. After applying these criteria, 262 patients were eligible and included in the final analysis.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurgical Technique and Postoperative Management\u003c/h3\u003e\n\u003cp\u003ePatients were assigned to one of two groups based on the postoperative ureteral stent management strategy.\u003c/p\u003e \u003cp\u003eIn the tie-on-Foley group, the distal end of the ureteral stent was secured to the Foley catheter at the conclusion of the procedure. The Foley catheter was removed on postoperative day (POD) 2, and patients were discharged the following day if no significant discomfort was reported.\u003c/p\u003e \u003cp\u003eIn the conventional group, the ureteral stent was placed without attachment to the Foley catheter. These patients had their Foley catheter removed on POD 1 and were discharged the same day once spontaneous voiding occurred without discomfort. The JJ stent was scheduled for removal 2\u0026ndash;4 weeks postoperatively.\u003c/p\u003e \u003cp\u003eThe choice between tie-on-Foley fixation and conventional indwelling stenting was made intraoperatively at the surgeon's discretion, based on intraoperative findings and the patient\u0026rsquo;s overall clinical status.\u003c/p\u003e\n\u003ch3\u003eOutcome Assessment and Statistical Analysis\u003c/h3\u003e\n\u003cp\u003ePostoperative outcomes were assessed using several clinical and procedural parameters, including operative time, length of hospital stay, postoperative pain measured using the visual analogue scale (VAS), and stone-free status confirmed by imaging at one month postoperatively. Stent-related complications, as well as unplanned emergency department (ED) visits or hospital readmissions within three months of surgery, were also recorded.\u003c/p\u003e \u003cp\u003eContinuous variables were compared between groups using either the independent-samples t-test or the Mann\u0026ndash;Whitney U test, depending on distributional characteristics. Categorical variables were analyzed using the chi-square test or Fisher's exact test, as appropriate.\u003c/p\u003e \u003cp\u003eTo identify predictors of postoperative complications, univariate logistic regression analyses were first conducted for all clinical variables. Variables with a \u003cem\u003ep\u003c/em\u003e value\u0026thinsp;\u0026lt;\u0026thinsp;0.10 in univariate analyses were included in a multivariable model to determine independent predictors. Results are reported as odds ratios (ORs) with corresponding 95% confidence intervals (CIs). A two-tailed \u003cem\u003ep\u003c/em\u003e value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 262 patients who underwent URSL were included in the study, comprising 58 patients in the tie-on-Foley group and 204 in the conventional stent group. Baseline demographic and clinical characteristics were largely comparable between groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), with no significant differences in age, sex, body mass index (BMI), comorbidities, renal function, or stone laterality. However, significant variations were observed in stone characteristics and infection parameters. The tie-on-Foley group had a higher proportion of lower ureteral stones and smaller mean stone size compared with the conventional group (0.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33 cm vs. 0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39 cm, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.022), whereas upper ureteric or ureteropelvic junction (UPJ) stones were more common in the conventional group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006). Preoperative pyuria was also more prevalent in the conventional group (57.7% vs. 37.5%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008).\u003c/p\u003e \u003cp\u003eOperative and postoperative outcomes are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The mean operative time was significantly shorter in the tie-on-Foley group than in the conventional group (22.9\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7 min vs. 28.3\u0026thinsp;\u0026plusmn;\u0026thinsp;18.7 min, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012). While hospital stay and the rate of outpatient surgery were comparable between groups, postoperative pain outcomes differed substantially. The tie-on-Foley group reported significantly higher VAS pain scores (4.06\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64 vs. 2.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.25, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), reflecting discomfort associated with simultaneous removal of the Foley catheter and ureteral stent. Correspondingly, short-term opioid use was more frequent in this group (37.9% vs. 15.7%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), followed by acetaminophen at discharge, whereas nearly all patients in the conventional group required postoperative nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control (97.5% vs. 56.9%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009).\u003c/p\u003e \u003cp\u003eDespite higher pain scores in the tie-on-Foley group, postoperative complications occurred significantly less often than in the conventional group (10.3% vs. 23.0%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.034). Postoperative fever was observed exclusively in the conventional group (8.3% vs. 0%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.023), potentially reflecting the longer indwelling duration of the JJ stent. Rates of gross hematuria, unplanned ED visits, and hospital readmissions were slightly higher in the conventional group, although these differences were not statistically significant. Postoperative renal function and stone-free rates at one month were comparable between the two groups.\u003c/p\u003e \u003cp\u003eRisk factors associated with postoperative complications were further analyzed using logistic regression (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Increased BMI (OR\u0026thinsp;=\u0026thinsp;1.10, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.041), dyslipidemia (OR\u0026thinsp;=\u0026thinsp;6.78, p\u0026thinsp;=\u0026thinsp;0.004), and stone location (OR\u0026thinsp;=\u0026thinsp;0.68, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.023) were identified as independent predictors of complications. Patients with lower ureteral or ureterovesical junction stones had a lower risk of developing complications compared with those with upper ureteric or UPJ stones. The presence of a conventional JJ stent (OR\u0026thinsp;=\u0026thinsp;2.67, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.087) and preoperative pyuria (OR\u0026thinsp;=\u0026thinsp;2.06, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.090) showed a trend toward increased complication risk, although these associations did not reach statistical significance.\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\u003eDemographic and clinical profile\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTie-on-Foley group (n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConventional group (n\u0026thinsp;=\u0026thinsp;204)\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 \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53.3\u0026thinsp;\u0026plusmn;\u0026thinsp;15.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.6\u0026thinsp;\u0026plusmn;\u0026thinsp;14.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.882\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.471\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (65.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123 (60.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (34.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81 (39.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.167\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystemic disease, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (39.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87 (42.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.166\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine, mg/dL (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.132\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of urolithiasis, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (48.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (36.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSide, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.895\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (49.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104 (51.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStone location, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.006*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUPJ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (4.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper third ureter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (32.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104 (51.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle third ureter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower third ureter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (44.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUVJ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (8.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStone size, cm (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.022*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHounsfield unit (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e605.1\u0026thinsp;\u0026plusmn;\u0026thinsp;367.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e608.4\u0026thinsp;\u0026plusmn;\u0026thinsp;381.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.958\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHydronephrosis, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (90.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e186 (91.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative pyuria, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113 (57.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.008*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eBMI: Body mass index, UPJ: Ureteropelvic junction, UVJ: Ureterovesical junction\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, statistically significant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\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\u003eOperative and postoperative outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTie-on-Foley group (n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConventional group (n\u0026thinsp;=\u0026thinsp;204)\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 \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative time, mins (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.88\u0026thinsp;\u0026plusmn;\u0026thinsp;12.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.29\u0026thinsp;\u0026plusmn;\u0026thinsp;18.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.012*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOPD surgery, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (26.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.492\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospitalization, days (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.76\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.174\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS score (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.06\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of NSAIDs, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (56.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e199 (97.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.009*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of Opioid, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (37.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (15.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of Tranexamic acid, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (18.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (23.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.034*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.023*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGross hematuria, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.633\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency visit rate, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (12.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.217\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReadmission, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.502\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative creatinine, mg/dL (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.745\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSFR, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e197 (96.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eOPD: Outpatient department, VAS: Visual analog scale, NSAIDs: Non-steroidal anti-inflammatory drugs, SFR: Stone-free rate\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, statistically significant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \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\u003e\u003cb\u003eLogistic regression analyses for predictors of postoperative complications\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLogistic regression\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOdds Ratio (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\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\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.02 (0.99\u0026ndash;1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.10 (1.00\u0026ndash;1.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.041 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative creatinine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.84 (0.54\u0026ndash;1.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.437\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConventional group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.67 (0.87\u0026ndash;8.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.087 \u003csup\u003ea\u003c/sup\u003e\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=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.68 (0.48\u0026ndash;0.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.023 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStone size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.35 (0.36\u0026ndash;4.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.657\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystemic disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.74 (0.15\u0026ndash;3.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.706\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.70 (0.20\u0026ndash;2.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.583\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.53 (0.13\u0026ndash;2.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.373\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyslipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.78 (1.81\u0026ndash;25.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.004 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDegree of hydronephrosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.21 (0.77\u0026ndash;1.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.411\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative pyuria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.06 (0.89\u0026ndash;4.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.090 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eBMI: Body mass index, UPJ: Ureteropelvic junction, UVJ: Ureterovesical junction\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e*: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, statistically significant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ea: Showed a trend toward increased risk but did not reach statistical significance\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis retrospective observational study compared two postoperative ureteral stent management strategies following URSL: the tie-on-Foley approach, which allowed early removal on POD 2, and the conventional JJ stent approach, with outpatient removal 2\u0026ndash;4 weeks postoperatively. Our results demonstrated comparable stone-free rates and overall postoperative outcomes between the two groups, while the tie-on-Foley approach offered additional advantages, including shorter drainage duration and fewer stent-related symptoms (SRS). These findings suggest that tie-on-Foley drainage may be a feasible and safe alternative to conventional stenting in selected patients undergoing uncomplicated URSL.\u003c/p\u003e \u003cp\u003eRoutine ureteral stenting after URSL has traditionally been recommended to prevent postoperative obstruction, ureteral edema, and hydronephrosis[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, recent studies indicate that omission or early removal of ureteral stents after uncomplicated URSL reduces SRS\u0026mdash;such as dysuria, frequency, urgency, and pain\u0026mdash;while improving short-term quality of life, without compromising stone clearance or increasing major adverse outcomes[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In our series, the tie-on-Foley group, functioning as short-term external drainage, exhibited a significantly lower overall complication rate compared with the conventional group (10.3% vs. 23.0%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.034) and no incidence of postoperative fever (0% vs. 8.3%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.023). There were no significant differences in stone-free rates, emergency visits, or unplanned readmissions. These observations align with prior studies showing that minimizing stent indwelling time reduces SRS and improves patient-reported outcomes without increasing procedure-related complications[\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. It is important to note that the conventional group had a significantly higher prevalence of preoperative pyuria (57.7% vs. 37.5%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008), which likely contributed to the higher febrile rate. However, our findings robustly demonstrate that for patients with relatively clean urine and uncomplicated stones, early stent removal via the tie-on-Foley technique does not increase the risk of postoperative infection, affirming its safety in this specific population.\u003c/p\u003e \u003cp\u003ePostoperative pain patterns differed between groups. Patients in the tie-on-Foley group reported higher mean VAS scores (4.06\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64 vs. 2.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.25, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), likely due to transient bladder discomfort associated with simultaneous removal of the Foley catheter and stent on POD 2. Consequently, these patients required more short-term opioid analgesics (37.9% vs. 15.7%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In contrast, patients in the conventional group relied more on NSAIDs for both febrile events and ongoing symptom control (97.5% vs. 56.9%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009), consistent with previous findings that prolonged JJ stent placement contributes to persistent irritative symptoms and discomfort[\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSimilar mechanisms\u0026mdash;such as trigonal irritation and vesicoureteral reflux caused by the distal stent coil\u0026mdash;have been proposed to explain stent-related discomfort[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Several pharmacologic strategies can alleviate these symptoms. For example, α-blockers reduce bladder irritation and smooth muscle spasm, while NSAIDs serve as adjuncts to decrease ureteral contractility and improve pain control, often functioning as opioid-sparing agents[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Although these approaches can mitigate discomfort, they do not completely eliminate SRS[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Nevertheless, pharmacologic therapy remains valuable for improving patient quality of life prior to stent removal[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn multivariable analysis, higher BMI (OR\u0026thinsp;=\u0026thinsp;1.10, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.041) and dyslipidemia (OR\u0026thinsp;=\u0026thinsp;6.78, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004) emerged as independent predictors of postoperative complications (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Both factors have been previously associated with increased stone burden[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, the finding regarding dyslipidemia warrants cautious interpretation. The wide confidence interval (1.81\u0026ndash;25.35) suggests statistical instability may be due to limited event outcomes rather than a direct pathophysiological link. Elevated BMI has also been linked to higher retreatment rates, greater postoperative complications, and lower stone-free rates, potentially predisposing patients to infection or delayed recovery[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Additionally, preoperative pyuria demonstrated a trend toward increased complication risk (OR\u0026thinsp;=\u0026thinsp;2.06, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.09), consistent with prior reports linking positive urine cultures to febrile events and urinary tract infections following URSL[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLiu et al. reported that JJ stent removal using an extraction string\u0026mdash;a method conceptually similar to the tie-on-Foley approach\u0026mdash;offers multiple benefits[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This technique avoids secondary cystoscopic removal, ensures safe drainage, and may reduce healthcare costs and patient anxiety without increasing the risk of urinary tract infection, emergency visits, dislodgement, or other complications[\u003cspan additionalcitationids=\"CR27 CR28\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Given the significant impact of SRS on quality of life[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], short-term drainage via tie-on-Foley stents may represent a pragmatic compromise between clinical efficacy and patient comfort.\u003c/p\u003e \u003cp\u003eOverall, these findings suggest that tie-on-Foley stent removal can facilitate smoother postoperative recovery by minimizing stent-related discomfort and reducing analgesic requirements, particularly in patients with small, distal ureteral stones. This strategy achieves a practical balance between adequate urinary drainage and patient-centered comfort.\u003c/p\u003e \u003cp\u003eSeveral limitations should be acknowledged. First, this was a single-center study performed by a single surgeon, which may limit generalizability but ensured procedural consistency. Second, baseline differences existed between groups, particularly in stone location and size (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), reflecting inherent selection bias. Patients with smaller, distal stones were more likely to receive tie-on-Foley drainage, based on surgeon assessment. These disparities may have influenced operative time\u0026mdash;which was longer in the conventional group (28.29\u0026thinsp;\u0026plusmn;\u0026thinsp;18.72 min vs. 22.88\u0026thinsp;\u0026plusmn;\u0026thinsp;12.69 min, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012)\u0026mdash;as well as postoperative outcomes, and thus the lower complication rate observed in the tie-on-Foley cohort may partly reflect underlying case complexity rather than the drainage method alone. Third, postoperative discomfort was recorded from clinical notes rather than using validated instruments such as the Ureteral Stent Symptom Questionnaire[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Lastly, the marked sample size disparity between the tie-on-Foley group (n\u0026thinsp;=\u0026thinsp;58) and the conventional group (n\u0026thinsp;=\u0026thinsp;204), along with the low number of complications, may have introduced bias or reduced statistical stability. For instance, the high odds ratio for dyslipidemia, accompanied by a wide confidence interval, may reflect these limitations and should be interpreted with caution. Future randomized controlled trials incorporating standardized symptom scoring are warranted to clarify the true benefits of the tie-on-Foley approach and to establish optimal patient selection criteria.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this retrospective study comparing ureteral stent management strategies following URSL, both tie-on-Foley and conventional approaches achieved comparable stone-free rates and postoperative renal function. Although patients in the tie-on-Foley group experienced transient discomfort at stent removal, this was effectively managed with short-term opioid use and simple analgesics after discharge. In contrast, the conventional group demonstrated higher rates of postoperative complications and febrile episodes, along with greater reliance on NSAID-based analgesia.\u003c/p\u003e \u003cp\u003eThese findings indicate that early stent removal via Foley catheter fixation is a feasible and safe alternative to conventional stenting, particularly for patients with smaller, distal ureteral stones. This approach may reduce SRS, shorten the duration of discomfort, decrease analgesic requirements, and potentially lower healthcare costs, without compromising surgical outcomes. Multicenter randomized trials are warranted to validate these results and to identify patient populations most likely to benefit from this simplified drainage strategy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eED\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEmergency department\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eJJ stent/ DJ stent\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDouble-J ureteral stent\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLaparoscopic ureterolithotomy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNSAID\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNon-steroidal anti-inflammatory drug\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOPD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOutpatient department\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCNL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePercutaneous nephrolithotomy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePOD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePostoperative day\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSFR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStone-free rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSRS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStent-related symptoms\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSWL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eShock wave lithotripsy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUPJ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUreteropelvic junction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eURSL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUreteroscopic lithotripsy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUVJ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUreterovesical junction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVisual analogue scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of Chi Mei Medical Center (Date: 2025/11/15 / No.: T-38284). Informed consent was waived due to the retrospective nature of the study. All patient data were de-identified and analyzed anonymously to ensure confidentiality.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003ch2\u003eCompeting Interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo funding was received for this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eWHT conceived and designed the study and critically revised the manuscript. PWW and PJC were responsible for data collection. PWW, HKW and PJC performed the data analysis and drafted the manuscript. WHT and HKW served as co-corresponding authors. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors extend their appreciation to the Department of Urology at Chi Mei Medical Center for their support in facilitating this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHuang WY, Chen YF, Carter S, Chang HC, Lan CF, Huang KH. Epidemiology of upper urinary tract stone disease in a Taiwanese population: a nationwide, population based study. 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J Urol. 2003;169(3):1060\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1097/01.ju.0000049198.53424.1d\u003c/span\u003e\u003cspan address=\"10.1097/01.ju.0000049198.53424.1d\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\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":"Ureteroscopic lithotripsy, Ureteral calculi, Ureteral stent, Postoperative complications, Early stent removal","lastPublishedDoi":"10.21203/rs.3.rs-8261668/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8261668/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo compare outcomes between early stent removal using tie-on-Foley fixation and conventional double-J stenting after ureteroscopic lithotripsy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study included 262 patients treated between January 2022 and December 2024. Patients were assigned to either the tie-on-Foley group (n = 58), with stent and Foley removed together on postoperative day 2, or the conventional group (n = 204), with stent removal after 2–4 weeks. Outcomes included operative time, pain scores, stone-free rates, and complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe tie-on-Foley group demonstrated significantly shorter mean operative times. While the tie-on-Foley group reported higher visual analogue scale scores at removal (4.06 versus 2.03, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) and required more short-term opioids, they experienced significantly fewer overall postoperative complications (10.3% versus 23.0%, \u003cem\u003ep\u003c/em\u003e = 0.034). Notably, postoperative fever was observed exclusively in the conventional group (8.3% versus 0%, \u003cem\u003ep\u003c/em\u003e = 0.023). Stone-free rates at one month were comparable between groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEarly stent removal via tie-on-Foley fixation is a safe strategy for selected patients with small, distal ureteral calculi and low infection risk. While it causes transient discomfort during removal, it is associated with fewer overall complications and avoids the morbidity of prolonged stenting without compromising surgical success.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number \u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration \u003c/strong\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Early Stent Removal via Tie-on-Foley Fixation versus Conventional JJ Stenting after Ureteroscopic Lithotripsy: A Retrospective Comparative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-09 10:08:43","doi":"10.21203/rs.3.rs-8261668/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":"cfa9c466-6c72-49d0-806c-9ac95d1bcdfd","owner":[],"postedDate":"January 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-22T10:25:42+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-09 10:08:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8261668","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8261668","identity":"rs-8261668","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}