Outcomes of stenting after uncomplicated ureteroscopy: systematic review and meta-analysis

Abstract

Objective: To investigate the potential beneficial and adverse effects of routine ureteric stent placement after ureteroscopy.

Design: Systematic review and meta-analysis of randomised controlled trials.

Data sources: Cochrane controlled trials register (2006 issue 2), Embase, and Medline (1966 to 31 March 2006), without language restrictions. Review methods We included all randomised controlled trials that reported various outcomes with or without stenting after ureteroscopy. Two reviewers independently extracted data and assessed quality. Meta-analyses used both fixed and random effects models with dichotomous data reported as relative risk and continuous data as a weighted mean difference with 95% confidence intervals.

Results: Nine randomised controlled trials (reporting 831 participants) were identified. The incidence of lower urinary tract symptoms was significantly higher in participants who had a stent inserted (relative risk 2.25, 95% confidence interval 1.14 to 4.43, for dysuria; 2.00, 1.11 to 3.62, for frequency or urgency) after ureteroscopy. There was no significant difference in postoperative requirement for analgesia, urinary tract infections, stone free rate, and ureteric strictures in the two groups. Because of marked heterogeneity, formal pooling of data was not possible for some outcomes such as flank pain. A pooled analysis showed a reduced likelihood of unplanned medical visits or admission to hospital in the group with stents (0.53, 0.17 to 1.60), although this difference was not significant. None of the trials reported on health related quality of life. Cost reported in three randomised controlled trials favoured the group without stents. The overall quality of trials was poor and reporting of outcomes inconsistent.

Conclusions: Patients with stents after ureteroscopy have significantly higher morbidity in the form of irritative lower urinary symptoms with no influence on stone free rate, rate of urinary tract infection, requirement for analgesia, or long term ureteric stricture formation. Because of the marked heterogeneity and poor quality of reporting of the included trials, the place of stenting in the management of patients after uncomplicated ureteroscopy remains unclear.

Fig 1 Flow of studies in the systematic review

Fig 2 Lower urinary tract symptoms in patients with and without stents after ureteroscopy

Fig 3 Urinary tract infections proved by culture in patients with and without stents after ureterosopy

Fig 4 Unplanned medical visits or admission to hospital in patients with and without stents after ureteroscopy

Fig 5 Operation time (minutes) in patients with and without stents during ureteroscopy