Safety and effectiveness of preoperative stenting compared to non-stenting in ureteroscopy for urinary stone disease: a meta-analysis of comparative studies.

Autor: Calvillo-Ramirez A; Division of Urology, University Hospitals Rainbow Babies and Children's, Cleveland, OH, USA., Angulo-Lozano JC; Department of Urology, Weill Cornell Medicine, 1240 York Av., New York, NY, 10065, USA. jangulo@rockefeller.edu., Del Rio-Martinez CJ; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico., Esparza-Miranda LA; Facultad de Medicina, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico., Perez Rodriguez Garcia G; University of Arizona, Phoenix, AZ, USA., Macías-Cruz HM; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico., Neto-Vivas BP; Facultad de Medicina, Universidad Central del Ecuador, Quito, Ecuador., Gonzaga-Carlos N; Department of Urology, General Hospital of Mexico, Mexico City, Mexico.
Jazyk: angličtina
Zdroj: World journal of urology [World J Urol] 2024 Dec 04; Vol. 43 (1), pp. 12. Date of Electronic Publication: 2024 Dec 04.
DOI: 10.1007/s00345-024-05365-8
Abstrakt: Purpose: Ureteroscopy (URS) is considered one of the first-line surgical treatments for urinary stones < 2 cm. Preoperative stenting (PS) employment in URS for urolithiasis remains debated, with evidence differing in terms of outcomes and recommendations. We sought to evaluate the influence of PS on surgical outcomes compared to non-PS (NPS) in patients with renal and ureteral stones undergoing ureteroscopic lithotripsy.
Methods: Databases were searched until December 2023 for randomized and non-randomized studies reporting perioperative outcomes for PS and NPS. Pooled data were analyzed through a Random-Effects model when Higgins I2% heterogeneity values were > 50%; otherwise, a Fixed-Effects model was employed. Results were reported as risk ratios (RR), or mean differences (MD) with 95% confidence intervals (CI). Statistical significance was set at p < 0.05.
Results: The analysis included 23,668 patients from 25 included studies (5 non-randomized prospective and 20 retrospective studies). Higher stone-free rates (SFR) were observed in kidney and ureteral stones (RR 1.05; 95%CI 1.03-1.08; p ≤ 0.0001), especially if managed with flexible URS (RR 1.05; 95%CI 1.01-1.09) in the PS cohort. Additionally, lower rates of intraoperative (RR 0.70; 95%CI 0.49-0.99; p = 0.04) and postoperative complications (RR 0.82; 95%CI 0.70-0.95; p = 0.008) were seen with PS. Both groups had a comparable operative time, length of stay (LOS), ureteral access sheath (UAS) placement success, and SFR in semi-rigid URS.
Conclusion: Higher SFR with PS were seen in kidney and ureteral stones, especially if f-URS was employed. Moreover, perioperative complications did not increase with PS. Future randomized studies, evaluating cost-effectiveness and quality of life are needed.
Competing Interests: Declarations. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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