Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
J Urol. 2011 Nov;186(5):1904-9. doi: 10.1016/j.juro.2011.06.066. Epub 2011 Sep 23.
We evaluated the necessity and adverse effects of routine ureteral stent placement after ureteroscopic lithotripsy for ureteral stones.
A systematic search of PubMed®, Embase® and the Cochrane Library was performed to identify all randomized controlled trials. All relevant studies were on the outcomes and complications of ureteroscopic lithotripsy in the management of ureteral stones with or without a Double-J stent. The outcomes and complications included stone-free rate, operative time, lower urinary tract symptoms, hematuria, fever, urinary tract infection, pain and analgesia, unplanned medical visits and late postoperative complications. The Cochrane Collaboration Review Manager software (RevMan 5.0.2) was used for statistical analysis.
A total of 16 randomized controlled trials were enrolled for analysis and involved 1,573 patients. Of these patients 797 were in the nonstented group and 776 in the stented group. There was a statistically significant difference in mean operative time between the 2 groups. The incidence of lower urinary tract symptoms and pain was significantly higher in the stented group than in the nonstented group. Significant differences between the groups were not found in fever, urinary tract infection, need for analgesia, unplanned readmission and late postoperative complications.
This systematic review reveals the obvious disadvantages of ureteral stents after ureteroscopic lithotripsy in lower urinary tract symptoms and pain. Stents do not improve stone-free rate, fever, incidence of urinary tract infection, unplanned medical visits, requirement for analgesia and late postoperative complications. Ureteral stenting after uncomplicated ureteroscopic lithotripsy could be unnecessary.
我们评估了输尿管镜碎石术后常规放置输尿管支架的必要性和不良反应，以治疗输尿管结石。
对 PubMed®、Embase®和 Cochrane 图书馆进行系统检索，以确定所有随机对照试验。所有相关研究均为输尿管镜碎石术治疗输尿管结石时是否放置双 J 支架的结局和并发症。结局和并发症包括结石清除率、手术时间、下尿路症状、血尿、发热、尿路感染、疼痛和镇痛、非计划就诊和术后晚期并发症。使用 Cochrane 协作网 RevMan 5.0.2 软件进行统计分析。
共纳入 16 项随机对照试验进行分析，涉及 1573 例患者。其中 797 例患者未放置支架，776 例患者放置了支架。两组患者的平均手术时间存在统计学差异。支架组患者的下尿路症状和疼痛发生率明显高于未放置支架组。两组患者在发热、尿路感染、需要镇痛、非计划再次入院和术后晚期并发症方面无显著差异。
本系统评价揭示了输尿管镜碎石术后放置输尿管支架在下尿路症状和疼痛方面的明显弊端。支架并不能提高结石清除率、发热、尿路感染发生率、非计划就诊、镇痛需求和术后晚期并发症。对于无并发症的输尿管镜碎石术，输尿管支架的放置可能是不必要的。
