Placement of ureteral stent after uncomplicated ureteroscopy: do we really need it?

OBJECTIVE

To investigate the role of stenting after uncomplicated ureteroscopy.

METHODS

This was a systematic review and meta-analysis of randomized controlled trials from MEDLINE, the Cochrane Central Search Library, and the EMBASE database. All of the studies reported various outcomes with or without stenting after ureteroscopy.

RESULTS

Fourteen trials were identified. As there was significant heterogeneity in pain assessment, difference in postoperative pain between the stent and nonstent groups was not clear. The incidence of dysuria, frequency, and hematuria was statistically significantly higher in stent group (relative risk [RR] 1.91, 95% confidence interval [95% CI] 1.18-3.08, dysuria; RR 2.23, 95% CI 1.48-3.36, frequency and urgency; RR 2.26, 95% CI 1.20-4.24, hematuria). There was no statistically significant difference in the postoperative analgesia requirement, urinary tract infections, postoperative fever, stone-free rate, and ureteral stricture between groups. There was a decreased tendency toward unplanned medical visits or hospital readmission in the stent group (RR 0.60, 95% CI .33-1.11), but the difference was not statistically significant. Combined analysis of the trials only used holmium laser or pneumatic lithotripsy showed no statistically significantly difference in unplanned medical visits between groups. Five studies found that ureteral stenting increased the expenses. Operation duration was significantly longer in the stent group (weighted mean difference 4.25, 95% CI 1.10-7.40).

CONCLUSIONS

A meta-analysis of the present literature revealed much benefit in the nonstent patient group. However, considering different outcome measures, marked clinical heterogeneity and various quality of, including trials, the place of stenting after uncomplicated ureteroscopy remains unclear.