***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE We determined the differences in outcome between ureteral stenting and nonstenting following uncomplicated ureteroscopy for distal ureteral stones . MATERIAL S AND METHODS A total of 220 patients treated with successful ureteroscopy for distal ureteral stones were r and omized to 2 equal groups according to postoperative placement of a ureteral stent ( Cook Irel and , National Technological Park , Irel and ) , including group 1 - -without a stent and group 2 - -with a stent . Outcome measures were flank pain and dysuria at 48 hours and 1 week , early postoperative complications , analgesia need , rehospitalization , return to normal physical activity , stone-free rate , stone recurrence and late postoperative complications .  Patients were followed a mean + /- SD of 25 + /- 9 months ( range 12 to 49 ) . RESULTS Early postoperative complications , including low grade fever , hematuria and urinary tract infection , were observed in 22 patients ( 20 % ) in group 1 and 19 ( 19 % ) in group 2 , a difference of no significant value . Mean initial hospitalization and time to return to normal physical activity were not different between the 2 groups . At 48 hours and 1 week there was no significant difference in flank pain between the 2 groups , while dysuria was significantly less in the nonstented group . The amount of analgesics required in the recovery room was not different but after discharge from the hospital stented patients used a larger amount of analgesia while the stent was still in the ureter . The stone-free rate at 4 weeks was 100 % in each group . Late postoperative sequelae , including stone recurrence and ureteral narrowing , were reported in 6 patients ( 5.5 % ) in group 1 and 4 ( 3.6 % ) in group 2 , a difference of no significant value . CONCLUSIONS Uncomplicated ureteroscopy for treatment of distal ureteral stones is safe without stent placement . Patients without stents have significantly fewer irritative bladder symptoms and are not at risk of increased complications PURPOSE We assessed the cost-effectiveness of routine ureteral stenting after ureteroscopic stone removal . MATERIAL S AND METHODS Of 295 consecutive patients who underwent rigid ureteroscopic stone removal 133 in group 1 and 162 in group 2 were r and omized to receive and not receive a stent , respectively , after the procedure . Operative time , stone size , stone location , success rate , postoperative pain and complications were analyzed in each group . RESULTS There were no statistically significant differences in the 2 groups regarding stone size , stone location , success rate , postoperative pain or complications . However , in group 1 operative time was significantly longer than in group 2 ( chi-square test p = 0.019 ) . The hospital charge per patient when placing and not placing a stent after ureteroscopy for stone removal was $ 9,900.95 and $ 3,661.78 , respectively . The female patients with a stent without a suture required an extra charge for stent removal in the operating room , while no men had a stent with a suture . CONCLUSIONS Routine catheter placement after ureteroscopic stone removal increased operative time and did not seem to improve patient outcome . The cost was 30 % that without a stent OBJECTIVES We conducted a study to assess the need for routine ureteral stenting after ureteroscopic stone removal using Lithoclast pneumatic intracorporeal lithotripsy . MATERIAL S AND METHODS A total of 104 patients , prospect ively divided in two groups to receive ( group A , 52 patients ) or not ( group B , 52 patients ) a stent after stone removal , underwent ureteroscopy for the treatment of ureteral lithiasis .  The procedure was performed with the patient under either general or epidural anesthesia . A semirigid ureteroscope ( Wolf 8.9 Fr ) was used in all cases and intracorporeal lithotripsy with ballistic energy was performed . In group A a double pigtail ureteral 4.8 or 6 Fr polyurethane stent was placed following ureteroscopy . All patients were closely evaluated on follow-up examinations . The outcomes measured were postoperative patient pain , lower urinary tract symptoms , the need for hospital care as a result of the postoperative pain and late postoperative complications . RESULTS The two patient groups were comparable with respect to the baseline variables of patient gender and age , stone location and mean stone size . Mean operative time plus or minus st and ard deviation ( S.D. ) in group A was 42 + /- 15 minutes ( range 20 - 65 ) compared to 37 + /- 20 ( range 15 - 60 ) in group B. Operative time was not significantly longer when a stent was placed ( p = 0.17 ) . At day 3 the mean visual analog pain score in group B was much higher than in group A ( p = 0.01 ) . Dysuria , hematuria and frequency/urgency were more prevalent in the stented group , although without statistically significant difference . Readmission to the hospital for unremitting pain was necessary in 12 of 104 patients ( 11.5 % ) all being in unstented group ( p < 0.05 ) . The incidence of anatomical ureteral narrowing on IVP at 6 months follow-up was not statistically different between the two groups . CONCLUSIONS In our experience , using Swiss Lithoclast ballistic energy to fragment stones , routine stent placement is advisable also after uncomplicated ureteroscopic lithotripsy without ureteral dilation . Further prospect i ve r and omized studies are needed to assess the role of stenting after ureteroscopic lithotripsy , considering different energies sources , scopes , diameter and site of the stones in the ureter PURPOSE Foregoing ureteral stents following ureteroscopy for urinary calculi is an evolving practice . R and omized trials support stent omission in select cases though generalizability is unclear and criteria for stentless ureteroscopy are unknown . Therefore , we sought to identify significant clinical characteristics affecting postoperative morbidity in unstented patients to provide a context for future r and omized trials . MATERIAL S AND METHODS Of 837 ureteroscopic procedures for urolithiasis performed at our institution from January 1997 through January 2002 a ureteral stent was not placed in 226 ( 32 % ) . Among these patients 47 had no stone at the time of the procedure leaving 219 ( 26 % ) who were treated for urinary calculus disease . Multivariate logistic regression was used to determine the association of 24 variables with postoperative morbidity . RESULTS Of the 219 patients treated with ureteroscopy  39 ( 18 % ) had a postoperative complication , which was obstructive in 26 ( 12 % ) , infectious in 10 ( 5 % ) , and related to patient co-morbidity in 3 ( 1 % ) . Factors associated with postoperative morbidity included renal pelvic location ( p = 0.02 ) , lithotripsy ( p = 0.03 ) , bilateral procedure ( p = 0.07 ) , history of urolithiasis ( p < 0.0001 ) , diabetes mellitus ( p = 0.06 ) , recent/recurrent infection ( p < 0.0001 ) , operative time 45 minutes or greater ( p = 0.07 ) , operative time 45 minutes or greater plus lithotripsy ( p = 0.0004 ) , operative time 45 minutes or greater plus ureteral dilation ( p = 0.07 ) and bilateral stentless procedure ( p = 0.005 ) . CONCLUSIONS Multiple patient and operative factors may predispose a patient to postoperative morbidity after a stentless procedure . Future trials should prospect ively vali date the role of these factors in either promoting ( e.g. , history of urolithiasis ) or preventing ( e.g. , preoperative stent ) a postoperative complication in the setting of stentless ureteroscopy PURPOSE A prospect i ve r and omized controlled trial was conducted to evaluate whether postoperative ureteral stenting is necessary after ureteroscopic laser lithotripsy . MATERIAL S AND METHODS A total of 58 patients with unilateral ureteral stones were r and omized into either stented or unstented groups . Ureteroscopic laser lithotripsy was performed using a semirigid ureteroscope ( 6.5/7Fr ) and holmium laser without ureteral orifice dilation . There were no selection criteria regarding stone size , location , preoperative ureteral obstruction and hydronephrosis . Endoscopic evidence of stone impaction or mucosal edema/damage did not exclude a patient from the study . Ureteral perforation on completion retro grade pyelogram was the only intraoperative criterion for study exclusion . Postoperative pain scores and symptoms were recorded . Excretory urography was performed to document stone-free status and stricture formation . Radionuclide scan was performed selectively to exclude functional obstruction when ureteral narrowing was found on excretory urogram . RESULTS Mean stone size + /- SD was 9.7 + /- 4.0 mm . ( range 4 to 27 ) . Proximal ureteral stones accounted for 43 % of all stones . Stented and unstented groups were comparable with respect to demographic data , stone parameters , preoperative obstruction and hydronephrosis . There was no significant difference in operating time , laser energy used , stone impaction and mucosal edema/damage between the 2 groups . Postoperative pain and symptoms were more severe and frequent ( p < 0.05 ) in the stented group . However , there was no difference in the incidence of postoperative sepsis and unplanned medical visits . The stone-free and stricture formation rates showed no statistical difference between the 2 groups . CONCLUSIONS Ureteral stenting is not necessary after uncomplicated ureteroscopic laser lithotripsy for ureteral stones . Ureteral stent increases the incidence of pain and urinary symptoms but does not prevent postoperative urinary sepsis and unplanned medical visits . Severity of preoperative obstruction and intraoperative ureteral trauma were not shown to be determining factors for stenting BACKGROUND / PURPOSE Whether the length of stent affects stent-related symptoms after urological procedures remains controversial . We aim ed to evaluate the predictive factors for stent-related urinary tract symptoms after uncomplicated ureteroscopic lithotripsy ( URSL ) . METHODS We prospect ively recruited a total of 59 patients who underwent URSL and 6-Fr double-J ureteral stent placement .  The demographic and perioperative data and stent characteristics , including the length ( 22 , 24 or 26 cm ) , position of proximal end ( upper calyx or pelvis ) , position of distal end ( crossing midline or not ) , and configurations of both ends ( complete or incomplete curl ) were recorded . All patients completed a self-administered question naire to evaluate the  stent-related urinary symptoms , bladder pain , flank pain and hematuria 1 week after the procedure . All variables were analyzed by a proportional odds logistic regression model . RESULTS Twenty-two male ( 37.3 % ) and 37 ( 62.7 % ) female patients were enrolled in this study . Their mean age was 53.7 ± 12.9 years . The mean body height was 161.9 ± 7.9 cm ( range , 145.9 - 178 cm ) . In multivariate analysis , the 26-cm stent was independently associated with the severity of frequency , urgency , and nocturia symptoms . Crossing the midline of the distal end was significantly associated with urge incontinence . The 24-cm and 26-cm stents were both very strongly associated with the severity of hematuria . Crossing the midline of the distal end was significantly associated with bladder pain . CONCLUSION The length of stent and crossing the midline of the distal end were significantly associated with stent-related symptoms after URSL . Selection of the proper length of double-J stent is the most important factor in minimizing stent-related symptoms 
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This fact does not exclude transurethral surgery using all new modifications of classic TURP .
Transurethral surgery has a significantly lower complication rate compared to open prostatectomy , although not with the laparoscopic modification .
A longitudinal incision can be dangerous when a huge adenoma ( for example 150 ml ) is removed because then damage of the sphincter during finger enucleation could occur .
Endolaparoscopic vision allows us to perform the incision precisely and enucleate a medium sized adenoma safely .
Longer catheterization than usual can be acceptable for any new/ developing procedure .
The approach and surgical space creation using EndoVision ® control is a bona fide advantage of laparoscopy .
On the other h and , finger enucleation allows substantial shortening of the operative time .