Image not available

Shen P et al, 2011: Use of ureteral stent in extracorporeal shock wave lithotripsy for upper urinary calculi: a systematic review and meta-analysis

Shen P, Jiang M, Yang J, Li X, Li Y, Wei W, Dai Y, Zeng H, Wang J
Department of Urology, West China Hospital, Sichuan University, Chengdu, China


Abstract

PURPOSE: This systematic review was performed to assess the necessity and complications of stenting before extracorporeal shock wave lithotripsy in the management of upper urinary stones.

MATERIALS AND METHODS: A systematic research of PubMed®, EMBASE® and the Cochrane Library was performed to identify all randomized controlled trials. The comparisons were about the outcomes and complications of extracorporeal shock wave lithotripsy in the management of upper urinary stones with or without Double-J stenting before extracorporeal shock wave lithotripsy, including stone-free rate, Steinstrasse, lower urinary tract symptoms, hematuria, fever, urinary tract infection, pain and analgesia, auxiliary treatment, and nausea and vomiting. We used the Cochrane Collaboration's Review Manager (RevMan) 5.0.2 software for statistical analysis.

RESULTS: Eight randomized controlled trials were included in analysis that reported 876 patients in total, divided into the stented group of 453 and the stentless group of 423. All studies recorded the stone-free rate and the results of the meta-analysis showed no difference between the groups (RR 0.97, 95% CI 0.91-1.03, p = 0.27). The total incidence of Steinstrasse in the stented group was similar to that of the stentless group with the exception of 1 study. However, the incidence of lower urinary tract symptoms was significantly higher in the stented group than in the stentless group (RR 4.10, 95% CI 2.21-7.61, p <0.00001). Significant differences could not be found in hematuria, fever, urinary tract infection, pain and analgesia, auxiliary treatment, or nausea and vomiting between the groups.

CONCLUSIONS: The systematic review suggested significant advantages of stenting before extracorporeal shock wave lithotripsy compared to in situ extracorporeal shock wave lithotripsy in terms of Steinstrasse. However, stenting did not benefit stone-free rate and auxiliary treatment after extracorporeal shock wave lithotripsy, and it induced more lower urinary tract symptoms. More high quality, randomized controlled trials are needed to address this issue.

Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
J Urol. 2011 Oct;186(4):1328-35. doi: 10.1016/j.juro.2011.05.073
PMID: 21855945 [PubMed - indexed for MEDLINE]

Rate this blog entry:
0
 

Comments 1

Hans-Göran Tiselius on Thursday, 11 August 2011 14:59

It has been repeatedly demonstrated in several previous studies that an internal stent does not improve the stone-free rates, but is associated with disturbing LUTS. The major reason for stenting presently is to avoid the obstructing complication of steinstrasse – a risk that is encountered when large stones are treated with ESWL. What in this regard is important is the definition of steinstrasse. The clinical problem appears when a large accumulation of fragments causes obstruction to the urine flow. In contrast an accumulation of fragments parallel with a stent -without obstruction- is a clinical problem of a much different character. From the results presented in Figure 3 of this publication stenting seems to favourably affect the outcome in terms of steinstrasse.

It is difficult to find out exactly which conclusion that the authors of this meta-analysis made. The statement in the Results section: "the total incidence of steinstrasse in the stented group was similar to that in the stentless group" seems to be contradictory to the final conclusion that there were "..significant advantages of stenting before extracorporeal shock wave lithotripsy compared to in situ extracorporeal shock wave lithotripsy in terms of steinstrasse".

My own conclusion is, however, is in line with the final conclusion in the text that stenting is very useful before treating patients with large stones in the kidney.

Hans-Göran Tiselius

It has been repeatedly demonstrated in several previous studies that an internal stent does not improve the stone-free rates, but is associated with disturbing LUTS. The major reason for stenting presently is to avoid the obstructing complication of steinstrasse – a risk that is encountered when large stones are treated with ESWL. What in this regard is important is the definition of steinstrasse. The clinical problem appears when a large accumulation of fragments causes obstruction to the urine flow. In contrast an accumulation of fragments parallel with a stent -without obstruction- is a clinical problem of a much different character. From the results presented in Figure 3 of this publication stenting seems to favourably affect the outcome in terms of steinstrasse. It is difficult to find out exactly which conclusion that the authors of this meta-analysis made. The statement in the Results section: "the total incidence of steinstrasse in the stented group was similar to that in the stentless group" seems to be contradictory to the final conclusion that there were "..significant advantages of stenting before extracorporeal shock wave lithotripsy compared to in situ extracorporeal shock wave lithotripsy in terms of steinstrasse". My own conclusion is, however, is in line with the final conclusion in the text that stenting is very useful before treating patients with large stones in the kidney. Hans-Göran Tiselius
Guest
Friday, 28 July 2017
STORZ MEDICAL AG
Lohstampfestrasse 8
8274 Tägerwilen
Switzerland
Tel.: +41 (0)71 677 45 45
Fax: +41 (0)71 677 45 05

www.storzmedical.com
Personal data
Address
Contact data
Message