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Wang H et al, 2017: Meta-Analysis of Stenting versus Non-Stenting for the Treatment of Ureteral Stones.

Wang H, Man L, Li G, Huang G, Liu N, Wang J.
Department of Urology, Beijing Jishuitan Hospital, Beijing, China.

Abstract

BACKGROUND AND AIM: Ureteroscopic lithotripsy (URL) and extracorporeal shock wave lithotripsy (ESWL) are two widely used methods for the treatment of ureteral stones. The need for ureteral stenting during these procedures is controversial. In this meta-analysis, we evaluated the benefits and disadvantages of ureteral stents for the treatment of ureteral stones.
METHODS: Databases including PubMed, Embase and Cochrane library were selected for systematic review of randomized controlled trials (RCTs) comparing outcomes with or without stenting during URL and ESWL. Meta-analysis was performed using RevMan 5.3 and STATA 13.0 software.
RESULTS: We identified 22 RCTs comparing stenting and non-stenting. The stented group was associated with longer operation time (WMD: 4.93; 95% CI: 2.07 to 7.84; p < 0.001), lower stone-free rate (OR: 0.55; 95% CI: 0.34 to 0.89; p = 0.01). In terms of complications, the incidence of hematuria (OR: 3.68; 95% CI: 1.86 to 7.29; p < 0.001), irritative urinary symptoms (OR: 4.40; 95% CI: 2.19 to 9.10; p < 0.001), urinary infection (OR: 2.23; 95% CI: 1.57 to 3.19; p < 0.001), and dysuria (OR: 3.90; 95% CI: 2.51 to 6.07; p < 0.001) were significantly higher in the stented group. No significant differences in visual analogue score (VAS), stricture formation, fever, or hospital stay were found between stenting and non-stenting groups. The risk of unplanned readmissions (OR: 0.63; 95% CI: 0.41 to 0.97; p = 0.04) was higher in the non-stented group.
CONCLUSIONS: Our analysis showed that stenting failed to improve the stone-free rate, and instead, it resulted in additional complications. However, ureteral stents are valuable in preventing unplanned re-hospitalization. Additional randomized controlled trials are still required to corroborate our findings.

PLoS One. 2017 Jan 9;12(1):e0167670. doi: 10.1371/journal.pone.0167670.

 

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Комментарии 1

Hans-Göran Tiselius в 02.08.2017 08:40

This is a meta-analysis of the effect of stenting in association with URS and SWL for ureteral stones. Without details of all 22 studies included in the analysis it is not clear how the stent was handled.

It seems reasonable to assume that for SWL the stents were present in the ureter during treatment. But for URS it is not clear if the stent was there before, during or after the procedure.

The conclusions in this report were that stenting did not improve the stone-free rate and was associated with more complications.

Initial observations on the value of a space of urine around the stone led to the assumption that insertion of a stent/ureteral catheter was of value when treating ureteral stones with SWL. This auxiliary measure also had the purpose of reducing impaction and oedema. Extensive subsequent experience has taught us that the result of SWL was similar without a ureteral catheter and without high diuresis [1]. It has, moreover, been my personal experience that in case of impacted stones it is rewarding to remove the stent immediately before SWL.

Reference

1. Tiselius HG, Aronsen T, Bohgard S, Fredriksson M, Jonason E, Olsson M,Sjöström K (2010) Is high diuresis an important prerequisite for successful SWL-disintegration of ureteral stones? Urol Res. 38: 143-146.

This is a meta-analysis of the effect of stenting in association with URS and SWL for ureteral stones. Without details of all 22 studies included in the analysis it is not clear how the stent was handled. It seems reasonable to assume that for SWL the stents were present in the ureter during treatment. But for URS it is not clear if the stent was there before, during or after the procedure. The conclusions in this report were that stenting did not improve the stone-free rate and was associated with more complications. Initial observations on the value of a space of urine around the stone led to the assumption that insertion of a stent/ureteral catheter was of value when treating ureteral stones with SWL. This auxiliary measure also had the purpose of reducing impaction and oedema. Extensive subsequent experience has taught us that the result of SWL was similar without a ureteral catheter and without high diuresis [1]. It has, moreover, been my personal experience that in case of impacted stones it is rewarding to remove the stent immediately before SWL. Reference 1. Tiselius HG, Aronsen T, Bohgard S, Fredriksson M, Jonason E, Olsson M,Sjöström K (2010) Is high diuresis an important prerequisite for successful SWL-disintegration of ureteral stones? Urol Res. 38: 143-146.
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