Original Paper
Urologia Urol Int 2009;83:70–74
Internationalis DOI: 10.1159/000224872
Choosing the Ideal Length of a Double-Pigtail
Ureteral Stent according to Body Height:
Study Based on a Chinese Population
Chen-Hsun Hoa, b Kuo-How Huanga Shyh-Chyan Chena Yeong-Shiau Pua
Shih-Ping Liua Hong-Jeng Yua
a
Department of Urology, National Taiwan University Hospital and College of Medicine, National Taiwan University, and
b
Department of Urology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan
Key Words
Double-pigtail ureteral stent ⴢ Ureteral obstruction ⴢ Stent
length
Abstract
Objective: We conducted this study to determine the ideal
stent length according to body height, as data are limited.
Patients and Methods: A total of 408 patients undergoing
ureteroscopic lithotripsy and stent insertion (22, 24 or 26 cm)
were enrolled. The appropriateness of the stent length was
determined according to the plain films and was further
compared among patients with different body heights and
stent lengths. Results: In patients !160 cm, the use of a 22-
cm stent was significantly more appropriate than a 24- or
26-cm stent (86.5, 51.9 and 46.4%). In patients between 160
and 175 cm, a 22- or 24-cm stent was significantly more ap-
propriate than a 26-cm stent (79.2, 66.7 and 46.3%), while the
difference between the use of a 22- and 24-cm stent was not
significant. In patients 1175 cm, a 24- or 26-cm stent might
be more appropriate. Conclusions: Body heights can predict
the ideal stent length. Based on a Chinese population, a 22-
cm stent length is more appropriate for those !175 cm.
A longer, 24- or 26-cm stent may be suitable for those
1175 cm. Copyright © 2009 S. Karger AG, Basel
© 2009 S. Karger AG, Basel
0042–1138/09/0831–0070$26.00/0
Fax +41 61 306 12 34
E-Mail karger@karger.ch Accessible online at:
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Received: February 27, 2008
Accepted after revision: July 20, 2008
Introduction
The double-pigtail ureteral stent has been widely used
to relieve or prevent ureteral obstruction since it was de-
scribed by Zimskind et al. [1] in 1967. Although inserting
a ureteral stent maintains ureteral patency and ensures
urinary drainage, some patients may have significant dis-
comforts, such as urinary frequency, urgency, inconti-
nence, hematuria, bladder pain and flank pain, which
have a negative impact on quality of life [2, 3]. Many of
these morbidities following stent insertion are related to
stent length. Various investigators have demonstrated
that an overlong intravesical segment of the ureteral stent
will cause more trigone irritation and subsequent bladder
symptoms [4–6]. On the contrary, a short stent may mi-
grate if either loop cannot coil well [7, 8], and in this situ-
ation, an additional procedure may be required to remove
it. Therefore, it is important to choose an appropriate stent
length to minimize these unpleasant complications.
Clinically, urologists or radiologists often choose the
length of a ureteral stent according to the patient’s habi-
tus, especially body height. It seems to be a practical and
reasonable method, and a few investigators have dealt
with this issue and support this idea [9, 10]. However, the
existent formula or method for choosing the appropriate
stent length according to body height is limited and
scarce. Besides, these studies are mostly based on Cauca-
sians, who are relatively taller. Whether these data are
Hong-Jeng Yu, MD
Department of Urology, National Taiwan University Hospital
No. 7, Chung-Shan South Road, Taipei 100 (Taiwan)
Tel. +886 2 2312 3456 ext. 2134, Fax +886 2 2321 9145
E-Mail hongjengyu@gmail.com

Fig. 1. Stent appropriateness is defined by the stent locations and
configurations. a A short stent, with either loop not curled com-
pletely. b An appropriate stent, with the intravesical loop not
across the midline (pubic symphysis) and the intrarenal loop in
the middle portion of the kidney shadow. c An overlong stent,
with the intravesical loops across the midline and/or the intrare-
nal loop in the upper pole.
applicable in Asians is unclear, as Asians are less tall and
have a relatively longer trunk than Caucasians [11]. In the
literature review, there is no formula or data based on
Asians for predicting an appropriate stent length.
In the present study, we enrolled 408 Chinese people
to investigate the relationship between body height and
appropriate stent length. We worked out a rule to predict
the appropriate stent length according to body height.
This will provide useful information for a surgeon to de-
termine the ideal stent length.
Patients and Methods
Study Population
Between January 2005 and April 2007, a total of 408 patients
with ureteral stones undergoing ureteroscopic lithotripsy in our
institution were enrolled. All the operations were performed in
the usual fashion with a 6-french ureteroscope (Wolf) and Hol-
mium-YAG laser. A double-pigtail ureteral stent was inserted at
conclusion of the operation. There were 2 options for the stent
diameter (6 or 7 F) and 3 options for the stent length (22, 24 and
26 cm), and the choices were up to the operators. All the stents
were made of polyurethane and manufactured by Cook Urologi-
cal (Cook Ireland Ltd.). On postoperative day 1, a kidney-ureter-
bladder (KUB) film was taken to confirm the presence of residu-
al stones and the stent configuration.
Exclusion criteria were procedures without stent insertion,
severe body deformity or disability, missing data on body habitus,
and missing postoperative KUB films.
Choosing Ideal Ureteral Stent Length
according to Body Height
Data Collection and Coding
The patients’ demographic data, including age, gender, height,
weight and body mass index (BMI), were reviewed and recorded
from the medical charts. All the KUB films were reviewed by a
urologist, who was blinded to patient characteristics. According
to the KUB films, the appropriateness of a stent was defined by
the stent location and configuration. It was categorized into 3
groups: (1) a short stent, with either loop not curled completely,
(2) an appropriate stent, with the intravesical loop not across the
midline (pubic symphysis) and the intrarenal loop in the middle
portion of the kidney shadow, and (3) an overlong stent, with the
intravesical loops across the midline and/or the intrarenal loop in
the upper pole (fig. 1).
Statistical Analysis
For statistical purpose, the patients were divided into 3 popu-
lations according to their body heights: !160 cm, between 160 and
175 cm, and 1175 cm. In each population, the patients were fur-
ther categorized into 3 groups according to the stent length (22,
24 and 26 cm). The numerical data were described by means and
standard deviations, and the categorical data were expressed as
counts and percentages. The numerical data (age, height, weight
and BMI) were compared with the t test. ␹2 or Fisher’s exact test
was used to compare the categorical data, including gender, stone
laterality and stent configuration. Two-sided tests were used, and
a p value !0.05 was considered to indicate statistical significance.
All data in the present study were analyzed with the commercial
statistical software (SPSS version 13.0 for windows, SPSS Inc.).
Results
Demographic Data
A total of 408 patients were included in the analysis.
The mean age was 52.2 8 12.8 years. The mean body
height was 163.8 8 8.7 cm: a total of 147 patients (36.0%)
were !160 cm, another 217 patients (53.2%) were between
160 and 175 cm, and only 44 patients (10.8%) were 1175
cm. The mean body weight was 69.7 8 13.3 kg, and the
mean BMI was 25.8 8 3.7. Of the 408 patients, 249 (61.0%)
were male and 187 (45.8%) had a right ureteral stone. A
total of 66 patients (16.2%) had a 22-cm stent, another 137
patients (33.6%) had a 24-cm stent, and the remaining
205 patients (50.2%) had a 26-cm stent (table 1).
Patients Shorter than 160 cm
In the patients !160 cm, the demographic data were
similar among the patients with different stent lengths
(table 2). The percentage of an appropriate stent length
was significantly higher with the use of a 22-cm (86.5%)
stent than with a 24-cm (51.9%) or a 26-cm (46.4%) stent
(p = 0.001 and p ! 0.001, respectively). The percentage of
an overlong stent was significantly lower with the use of a
22-cm (2.7%) compared with a 24-cm (33.3%) or a 26-cm
Urol Int 2009;83:70–74 71
Table 1. Patient demographics
Variables All patients
Patients 408
Patient age, years 52.2812.8
Males 249 (61.0)
Body height, cm 163.888.7
Patients <175 cm 147 (36.0)
Body weight, kg 69.7813.3
BMI 25.883.7
Right urolithiasis 187 (45.8)
Stent length
22-cm stent 66 (16.2)
24-cm stent 137 (33.6)
26-cm stent 205 (50.2)
Data are presented as n (%) or mean 8 SD.
(48.2%) stent (both p ! 0.001). With respect to the per-
centage of the incomplete curls, there was no significant
difference among the 3 stent length groups (table 3).
Patients with a Height between 160 and 175 cm
In this range of body heights, patient demographic data
were similar among the patients with different stent lengths
(table 2). The percentage of an appropriate length was sig-
nificantly higher with the use a 22-cm (79.2%) or a 24-cm
(66.7%) stent than with a 26-cm (46.3%) stent (p = 0.003
and p = 0.007, respectively). Although a 22-cm stent seemed
to be more appropriate in this population, the difference
between the uses of a 22-cm and a 24-cm stent was not sta-
tistically significant (p = 0.25). The percentage of an over-
long stent was significantly lower with the use a 22-cm
(8.3%) or a 24-cm (21.7%) stent in comparison with a
26-cm (47.2%) stent (both p ! 0.001). There was no sig-
nificant difference regarding the percentage of incomplete
curls among the 3 stent length groups (table 3).
Patients Taller than 175 cm
Only a small number (10.8%) of the patients were 1175
cm. The mean body height of the patients with a 26-cm
stent (178.2 8 2.4 cm) was higher than those with a 22-
cm (176.5 8 0.8 cm) and 24-cm (176.4 8 1.3 cm) stent
(p = 0.116 and p = 0.002, respectively). Other demograph-
ic data were similar among the 3 groups. With regard to
the stent configurations, there was no significant differ-
ence among the 3 groups. The percentage of an appropri-
ate stent length was higher in the patients with a 24-cm
(92.9%) stent, although the difference was not statistical-
ly significant. Two (40%) of the patients with a 22-cm
stent had incomplete curls (table 3).
Comment
Several methods have been described to determine the
appropriate stent length: (1) intraoperative direct measure-
ment of the ureter itself using a guidewire [12] or an endo-
catheter ruler [13, 14], (2) measurement of the distance
from the ureteropelvic to the ureterovesical junction with
intravenous urography (IVU) [15, 16], and (3) estimation
from a formula based on the patient’s height [9].
Theoretically, intraoperative direct measurement with
a guidewire or an endocatheter ruler can provide an ac-
tual ureteral length. However, the method requires addi-
tional procedures and radiation exposure, which makes
it more time consuming and less practical.
Measurement of the ureteral length with IVU has been
demonstrated to be correlated with the actual ureteral
length [15]. However, little evidence supports that this
method can determine the ideal stent length and the sub-
sequent satisfactory stent location and configuration. Be-
sides, an IVU study may not be available for all patients,
which makes this technique useless in this situation.
A formula based on body height is much easier than
other methods mentioned earlier. Whether body height
can predict the ureteral length and the subsequent ideal
stent length has been investigated, and the results were
controversial [9, 10, 14]. In the study of Shah and Kulkar-
ni [14], they assessed the relationship between the body
height and the ureteral length measured by a guidewire
method. In this study, there was no significant correla-
tion. On the contrary, Hruby et al. [10] concluded that
body height correlated most with ureteral length, as well
as with other body habitus, including body weight, the
distance from the shoulder to the wrist, and the distance
from the xyphoid process to the pubis. However, although
these measurements highly correlated with ureteral
length, they could not fairly predict the ureteral length in
the study.
The failure to predict ureteral length by body height
may be explained as follows. It is possible that patients
with a certain range of body heights may have a similar
or approximate ureteral length. As shown in the present
study, body heights between individuals vary in a wider
range, while their ureteral lengths may vary in a narrower
range. Therefore, even if the taller patients have a longer
ureter, it is still difficult to demonstrate the prediction

72 Urol Int 2009;83:70–74 Ho/Huang/Chen/Pu/Liu/Yu

 Table 2. Demographics (grouped by body height and stent length for comparison)

Stent length p value

22 cm 24 cm 26 cm p(A) p(B) p(C)

Patients <160 cm
Patients 37 54 56
Patient age, years 58.7811.4 56.7810.5 57.7812.3 0.384 0.694 0.637
Males 9 (24.3) 12 (22.2) 14 (25.0) 0.815 0.941 0.732
Body height, cm 153.684.8 154.883.7 154.983.9 0.221 0.197 0.920
Body weight, kg 58.789.7 58.8810.5 61.387.9 0.983 0.170 0.160
BMI 24.983.8 24.584.4 25.683.5 0.711 0.347 0.163
Right urolithiasis 18 (48.6) 25 (46.3) 29 (51.8) 0.825 0.767 0.565
Patients between 160 and 175 cm
Patients 24 69 123
Patient age, years 50.2810.9 51.4812.2 50.4812.6 0.658 0.947 0.569
Males 19 (79.2) 53 (76.8) 98 (79.7) 0.812 1.000 0.642
Body height, cm 167.384.5 167.184.8 167.384.3 0.836 0.948 0.802
Body weight, kg 73.6810.4 73.4812.0 73.9812.0 0.946 0.897 0.771
BMI 26.282.8 26.283.6 26.484.0 0.986 0.757 0.733
Right urolithiasis 12 (50.0) 33 (47.8) 53 (43.4) 0.854 0.555 0.527
Patients >175 cm
Patients 5 14 26
Patient age, years 42.089.2 40.3811.2 42.7812.2 0.763 0.906 0.545
Males 5 (100.0) 14 (100.0) 25 (96.2) N/A 1.000 1.000
Body height, cm 176.580.8 176.481.3 178.282.4 0.842 0.116 0.002
Body weight, kg 80.282.9 80.987.3 84.688.5 0.772 0.052 0.176
BMI 25.881.0 26.082.4 26.682.6 0.737 0.202 0.473
Right urolithiasis 2 (40.0) 6 (42.9) 9 (34.6) 1.000 1.000 0.608

Data are presented as n (%) or mean 8 SD. N/A = Not accountable. p(A) compares values between the 22-
and the 24-cm group. p(B) compares values between the 22- and the 26-cm group. p(C) compares values be-
tween the 24- and the 26-cm group.

Table 3. Body heights, stent lengths and the percentage of appropriateness

Stent length p value

22 cm 24 cm 26 cm p(A) p(B) p(C)

Patients <160 cm
Incomplete curls 4 (10.8) 8 (14.8) 3 (5.4) 0.755 0.329 0.098
Appropriate length 32 (86.5) 28 (51.9) 26 (46.4) 0.001 <0.001 0.569
Overlong stent 1 (2.7) 18 (33.3) 27 (48.2) <0.001 <0.001 0.113
Patients between 160 and 175 cm
Incomplete curls 3 (12.5) 8 (11.6) 8 (6.5) 1.000 0.388 0.221
Appropriate length 19 (79.2) 46 (66.7) 57 (46.3) 0.250 0.003 0.007
Overlong stent 2 (8.3) 15 (21.7) 58 (47.2) 0.221 <0.001 <0.001
Patients >175 cm
Incomplete curls 2 (40.0) 1 (7.1) 1 (3.8) 0.155 0.060 1.000
Appropriate length 3 (60.0) 13 (92.9) 21 (80.8) 0.155 0.562 0.399
Overlong stent 0 (0) 0 (0) 4 (15.4) N/A 1.000 0.278

Figures in parentheses are percentages. N/A = Not accountable. p(A) compares values between the 22- and
the 24-cm group. p(B) compares values between the 22- and the 26-cm group. p(C) compares values between
the 24- and the 26-cm group.

Choosing Ideal Ureteral Stent Length Urol Int 2009;83:70–74 73

according to Body Height
ability of the body height if it is treated as a continuous and
numerical parameter. In this issue, we suggest that body
height should be viewed as an ordinal and categorical vari-
able. Thus, it can easily predict the ureteral length or the
ideal stent length, as shown in our study and in the study
of Pilcher and Patel [9]. In their study, a formula based on
the patient’s height predicted the correct stent length in
61% of the patients, compared with 17% by intraoperative
measurement of the ureteral length with a guidewire. Be-
sides, all their patients !178 cm were inserted with a 22-
cm stent with a good result. It is compatible with our find-
ings that a 22-cm stent is suitable for those !175 cm.
In the present study, a total of 38 patients (9.3%) had
incomplete curls, which raised the concern of stent mi-
gration as mentioned by the previous study [7]. In fact, no
stent migration occurred in our study, because all these
‘incompletely curled’ stents were partially curled and
close to totally curled. A curl 1180 degrees has been
shown to be enough to hold the stent in situ [7].
Another interesting finding in our study is that a lon-
ger stent is often chosen according to the operators’ pref-
erence, mostly in fear of stent migration. The present
study reveals that a near 90% of our patient population
are !175 cm, and a 22-cm stent can well fit this popula-
tion. On the contrary, based on the operators’ preference,
only 66 (16.2%) of the 408 patients had a 22-cm stent,
while the rest (83.8%) had a relatively longer one. The
overestimation of the actual stent length will result in
more discomforts rather than do any help.
The present study has some limitations. It is not a pro-
spective and randomized study. However, we believe that
our analysis and results were not biased too much. Wheth-
er a 22-cm stent can fit patients 1175 cm was difficult to
evaluate due to the relatively small sample size. However,
incomplete curls occurred in 2 (40%) of the 5 patients
who were 1175 cm and had a 22-cm stent, indicating that
a 22-cm stent might be relatively short for this popula-
tion. In this taller population, a 24-cm stent may be more
appropriate.
Conclusions
Body heights can successfully predict the ideal stent
length. Based on a Chinese population, a 22-cm ureteral
stent is more appropriate for patients !175 cm, comprising
a near 90% of all patients. A longer ureteral stent of 24 or
26 cm may be suitable for those who are 1175 cm, account-
ing for the remaining 10% of our patient population.

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