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

purposeUreteroscopy (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.

methodsDatabases 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.

resultsThe 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.

conclusionHigher 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.