Rethinking postoperative drainage after ureteroscopy with flexible and navigable ureteral access sheaths (FANS): Is Same-Day MonoJ Stenting Safe?

Kidney stones are a painful reality for millions, often requiring a procedure where a surgeon threads a thin, flexible camera up the urinary tract to break the stones into dust. For decades, the standard practice after such a successful operation has been to leave a small, plastic tube inside the patient's body for days or weeks. This tube, known as a stent, acts as a temporary scaffold to keep the ureter—the narrow tube connecting the kidney to the bladder—open while it heals from the swelling caused by the surgery. While this tube prevents blockages, it is notorious for causing significant discomfort, including sharp pain, frequent urges to urinate, and blood in the urine, often ruining a patient's quality of life during recovery.

Medical guidelines have long suggested that this routine tube might not be necessary for every patient, yet in practice, most surgeons still place one out of an abundance of caution. The fear is that without it, swelling could trap urine or leftover stone fragments, leading to complications. However, a new generation of surgical tools is changing the landscape. These tools include a specialized sheath that not only guides the camera but also actively sucks out stone dust and fluid, keeping the pressure inside the kidney low and the view clear. This advancement raises a simple but profound question: if the surgeon can see clearly that all the stones are gone and the tube is unharmed, is it truly necessary to leave a painful tube inside the patient for days, or can the patient go home the same day with a much shorter period of drainage?

A team of researchers at Hospital Aleman in Argentina set out to answer this question by testing a bolder approach on a carefully selected group of patients. They focused on individuals who underwent a specific type of kidney stone surgery using a flexible, navigable suction sheath. The key to their strategy was strict selection. They only included patients who entered the surgery without an active infection, who had every single stone fragment removed by the end of the procedure, and whose ureters showed no signs of injury after the surgical tools were inserted and removed. For these 167 patients, the surgeons did not place the traditional long-term tube. Instead, they inserted a temporary, single-jet catheter that drained urine for only a few hours before being removed entirely before the patient left the hospital.

The results of this experiment were strikingly clean. In every single one of the 167 procedures, the surgeons confirmed that the patients were completely free of stone fragments when checked with a scan four weeks later. More importantly, no patient suffered any complications that required a return to the hospital or a second procedure. There were no instances of blocked urine flow, no infections, and no unmanageable pain that forced a change in the plan. The patients were able to have the temporary catheter and their urinary catheter removed just six to eight hours after the surgery and went home the same day, bypassing the weeks of discomfort usually associated with the traditional stent.

This outcome suggests that for a specific group of patients—those with clean surgeries, no infections, and no damage to the urinary tube—the traditional long-term stent may be an unnecessary burden. The researchers found that the combination of the advanced suction tool, which clears debris efficiently, and the surgeon's ability to confirm a perfect result during the operation, creates a safe environment where the body can heal without prolonged internal support. The study indicates that leaving a tube in for days is not a universal requirement for safety, provided the surgery is flawless and the patient is healthy to begin with.

However, the researchers are careful to note that this approach is not a one-size-fits-all solution. The success of this method relied entirely on the rigorous selection of patients and the high skill level of the surgeons performing the operations. The study was conducted at a single center by experienced specialists, and the patients were chosen specifically because they had no risk factors like infections or visible injuries. The authors acknowledge that their findings are preliminary and that the approach cannot be applied to every kidney stone surgery. They emphasize that while the results are promising, larger studies involving different hospitals and a wider variety of patients are needed to confirm that this same-day, tube-free recovery is safe for the general population. Until then, the decision to skip the long-term stent remains a careful calculation, reserved for the most ideal cases where the surgery goes perfectly.