698 JOURNAL OF ENDOUROLOGY Volume 21, Number 7, July 2007 © Mary Ann Liebert, Inc. DOI: 10.1089/end.2007.9949 Rapid Communication: Effects of Proximal and Distal Ends of Double-J Ureteral Stent Position on Postprocedural Symptoms and Quality of Life: A Randomized Clinical Trial* AHMED M. AL-KANDARI, M.D., 1,2 TARIQ F. AL-SHAIJI, M.D., 1 HANI SHAABAN, M.D., 1 HAMDY M. IBRAHIM, M.D., 1 YEHYA H. ELSHEBINY, M.D., 1 and AHMED A. SHOKEIR, M.D., Ph.D., FEBU 3 ABSTRACT Purpose: To evaluate the effect of the position of the proximal and distal ends of Double-J ureteral stents on postprocedural flank pain, lower urinary-tract symptoms, and quality of life. Patients and Methods: The study included 120 patients who required unilateral Double-J ureteral stents for various indications. They were randomized into two equal groups. Group 1 had longer stents, with the prox- imal end in the upper calix and the distal end crossing the midline of the bladder. Group 2 had proper stent length with the proximal end in the pelvis and the lower end just beyond the vesicoureteral junction. Patients answered a questionnaire regarding flank pain, dysuria, and urgency as well as quality of life after 1 week of stenting. Results: Forty patients (67%) of group 1 and 43 (72%) of group 2 had mild flank pain, especially during urination. There was no significant difference in the degree of flank pain in the two groups. Moderate to se- vere dysuria was reported by 53 patients (88%) in group 1 and 11 patients (18%) in group 2 (P  0.001). Moderate to severe urgency was reported by 48 patients (80%) in group 1 and in 14 (23%) in group 2 (P  0.001). A worse quality of life was reported by patients in group 1, among whom moderate to severe bother was noted by 51 (85%) compared with group 2, in which moderate to severe bother was reported by only 13 patients (22%) (P  0.001). Conclusion: Ureteral stents are associated with flank pain and lower urinary-tract symptoms. The flank pain was not affected by the length of stent. Urgency and dysuria as well as a worse quality of life were sig- nificantly more common in the patients who had longer stents. INTRODUCTION D OUBLE-J URETERAL STENTS are widely used in uro- logic procedures for maintaining upper urinary-tract drainage and to relieve obstruction, pain, or infection. How- ever, stents are associated with significant morbidity such as flank pain, infection, encrustation, hematuria, and bothersome symptoms, the most common of which are dysuria, frequency, and urgency. 1-3 There is a general agreement that a stent can result in trigo- nal irritation. Nevertheless, to our knowledge, no assessment has been made in a randomized manner as to whether patients with long stents experience more trigonal irritation than those with stents of the proper length. Herein, we present a random- ized clinical trial aimed at studying the effect of the position of the proximal and distal ends of Double-J ureteral stents on post- procedural flank pain, bothersome symptoms, and quality of life. 1 Urology Unit, Adan Hospital, Kuwait. 2 Department of Surgery, Kuwait University, Kuwait. 3 Mansoura Urology & Nephrology Center, Mansoura, Egypt. *Presented at the 24 th World Congress of Endourology, Cleveland, OH, August 2006.