Meta-analysis of postoperatively stenting or not in patients underwent ureteroscopic lithotripsy

Abstract

The aim of this study was to evaluate the necessity for stenting after ureteroscopic lithotripsy. We performed a systematic research of Medline, Embase, Cochrane central registration for RCTs concerning the comparison between stented and non-stented post-ureteroscopic procedures for stone removal and reference lists of the included study were also screened. 15 trials were included and data related was extracted and analyzed in meta way. No difference was detected in stone free rate and stricture formation between the two groups (P = 0.69; P = 0.67). Participants with stents had higher risk of being infected than those without, RR = 1.72, but with no difference. Stent related lower urinary symptoms were more frequently experienced by stented patients, dysuria (RR = 5.24, P = 0.003); hematuria (RR = 7.28, P = 0.001); loin voiding pain (RR = 5.24, P = 0.003). Postoperative pain score were also higher in patients with stent in the early period after surgery with mean difference 0.95 (P = 0.002). With additional time needed for the placement of stent, the operative time in stented patients were 3.36 min longer than those without stenting (P = 0.02). The additional cost for longer operative room stay, together with the sent and cystoscopic stent removed conditionally, and made the cost for stented patients much higher. No difference were detected in length of hospital stay between both groups (P = 0.22), the stented patients were even of lower rate pay unplanned hospital visit (RR = 0.81, P = 0.55). Stenting did not improve the outcome of patients who underwent ureteroscopic lithotripsy, but associated with increased complication rate. Routinely stenting after ureteroscopic procedure for stone removal was not necessary; however, it still should be reserved conditionally.