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Review
. 2025 Aug 12;43(1):489.
doi: 10.1007/s00345-025-05848-2.

The influence of pre-stenting and drugs on the outcomes of ureteroscopy for kidney and ureteral stone disease: a systematic review and meta-analysis by the EAU Section of Endourology

Steffi Kar Kei Yuen  1   2 , Daniele Castellani  3   4 , Theodoros Tokas  3   5   6 , Giacomo Maria Pirola  7 , Carlo Giulioni  8 , Jia-Lun Kwok  3   9 , Mohamed Amine Lakmichi  10 , Takafumi Yanagisawa  11 , Amelia Pietropaolo  12 , Thomas Herrmann  3   13 , Bhaskar Somani  3   12 , Vineet Gauhar  3   14
Affiliations
Review

The influence of pre-stenting and drugs on the outcomes of ureteroscopy for kidney and ureteral stone disease: a systematic review and meta-analysis by the EAU Section of Endourology

Steffi Kar Kei Yuen et al. World J Urol. .

Abstract

Introduction: Ureteroscopy serves as a minimally invasive surgical treatment option for ureteral and kidney stones but is not without technical challenges. Pre-stenting and medical therapies, such as alpha-blockers, may improve outcomes by facilitating ureteral access sheath placements and reducing complications. This systematic review and meta-analysis aimed to evaluate the effects of pre-stenting and preoperative pharmacological agents on ureteroscopy outcomes.

Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. A comprehensive literature search was performed across multiple databases, identifying randomized controlled trials comparing ureteroscopy outcomes with and without pre-stenting and pre-ureteroscopy medical therapy. Primary outcomes included failure rates in accessing the upper urinary tract, while secondary outcomes encompassed operative times, complications, and stone-free rates.

Results: The analysis included 16 randomized controlled trials, revealing that pre-stenting and medical therapy significantly reduced failure rates (Relative Ratio 0.44, 95% CI 0.33-0.59, p < 0.001) and operative times (Mean Difference -10.81 min, 95% CI -13.45 to -8.18, p < 0.001). Additionally, there was a higher stone-free rates, lower need for postoperative stenting and fewer complications associated with preoperative ureteral dilation interventions.

Conclusion: Preoperative alpha blockers enhance ureteroscopy success and reduces complications. The evidence supports their use before ureteroscopy for renal and ureteral stones, improving patient outcomes and procedural efficiency. Patients pre-stented for any reason demonstrated significantly improved ureteroscopic access and stone-free rates.

Keywords: Alpha-blocker; Kidney stone; Pre-stenting; Silodosin; Tamsulosin; Ureteral; Ureteroscopy.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests. Ethical approval: Ethics approval is not required in this study.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Results of Meta-analysis comparing drug or pre-stenting versus placebo
Fig. 2
Fig. 2
Results of Meta-analysis comparing drug or pre-stenting versus placebo
Fig. 2
Fig. 2
Results of Meta-analysis comparing drug or pre-stenting versus placebo
Fig. 2
Fig. 2
Results of Meta-analysis comparing drug or pre-stenting versus placebo
Fig. 2
Fig. 2
Results of Meta-analysis comparing drug or pre-stenting versus placebo
See this image and copyright information in PMC

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