Impact of Preoperative Stenting on the Outcome of Flexible Ureterorenoscopy for Upper Urinary Tract Urolithiasis: A Systematic Review and Meta-Analysis

Abstract

<b><i>Purpose:</i></b> This study aimed to investigate the effect of preoperative stenting (POS) on the perioperative outcomes of flexible ureterorenoscopy (fURS). <b><i>Materials and Methods:</i></b> A systematic review and meta-analysis was conducted based on the PRISMA statement. From the initially retrieved 609 reports, we excluded the ineligible studies at 2 stages. We only included studies that contained fURS patients with and without POS in the same report. Data of patients who underwent semirigid ureteroscope only were excluded from the analysis. The Newcastle-Ottawa Scale (NOS) system was applied for risk of bias assessment. <b><i>Results:</i></b> A total of 20 studies including 5,852 patients were involved. 48.5% of the patients had preoperative stent. Stone-free rate was significantly higher with prestenting; odds ratio (OR) was 1.98 (95% CI: 1.51–2.58) (<i>Z</i> = 5.02; <i>p</i> = 0.00001). It also displayed tendency toward lower complications; OR was 0.74 (95% CI: 0.52–1.05) (<i>Z</i> = 1.67; <i>p</i> = 0.09). POS significantly increased the use of ureteral access sheath; OR was 1.49 (95% CI: 1.05–2.13) (<i>Z</i> = 2.22; <i>p</i> = 0.03). Risk of bias assessment showed 13 and 7 studies with low and moderate risk, respectively. <b><i>Conclusions:</i></b> POS clearly improves the stone-free rates after fURS. It might reduce the complications, especially ureteral injury. These findings might help solve the current debate and can be useful for urologists during patient counselling for a proper decision-making.