The effect of preoperative ureteral stenting on the outcomes and complications of pediatric ureteroscopy: A systematic review and meta-analysis

Abstract

Introduction: Small ureteral caliber may prohibit safe primary ureteroscopy (URS), particularly in children. Pre-stenting was proposed to passively dilate the ureter for later safer ureteral access. This meta-analysis aims to analyze outcomes of both primary and deferred ureteroscopy after a period of pre-stenting.

Methods: PubMed, Scopus, Cochrane Library, and Web of Science were searched for studies comparing outcomes of primary and deferred ureteroscopy in children younger than 18 years with ureteral and/or renal stones. Outcomes of interest were stone free rate (SFR), complication rates, ureteral injury, urinary tract infection (UTI), operative time, stone migration, postoperative stenting use and ureteral access sheath use.

Results: Four studies encompassing 826 patients were included. When attempted, primary ureteroscopic access was successful in 69-83 % of patients. SFR was higher in the pre-stenting group (OR 0.87, 95 % CI [0.81-0.94], P = 0.0005). No significant difference was found between the two groups in terms of the overall complications rate (RR 1.66, 95 % CI [0.93-2.96], P = 0.09), ureteral injury (RR 3.67, 95 % CI [0.43-31.66], P = 0.24) febrile UTI (RR 0.62 (95 % CI [0.15 to 2.5], P = 0.5), use of postoperative stent (OR 0.86, 95 % CI [0.52-1.44], P = 0.58), use of ureteral access sheath (RR 0.94 (95 % CI [0.73 to 1.22], P = 0.65), or stone migration (RR 2.28 (95 % CI [0.48 to 10.80], P = 0.30).

Conclusion: Although pre-stenting is associated with a relatively higher SFR, primary URS is successful in most pediatric patients without increased complication risk. We advocate primary URS whenever possible to allow stone treatment under a single anesthetic and minimize healthcare costs.

Keywords: Pediatrics; Stent; Ureteroscopy; Urolithiasis.