PURPOSE: Post-ureteroscopy ureteral stent omission remains controversial. Although omission is associated with reduced postoperative discomfort, concern remains for early obstruction. We performed a systematic review and meta-analysis of trials that compare the risk of unplanned visits with and without stent following ureteroscopy for nephrolithiasis.
METHODS: Randomized controlled trials (RCT) and observational studies comparing post-ureteroscopic stent omission versus placement and reporting unplanned visits within 30 days were identified via a search of MEDLINE (1946-2015), CENTRAL (1898-2015), EMBASE (1947-2015), ClinicalTrials.gov (1997-2015), AUA Annual Meetings abstracts (2011-2015), and reference lists of included articles, last updated in October 2015. Two reviewers independently extracted data and assessed methodological quality. Odds ratios (OR), relative risks (RR), and weighted mean differences (WMD) were calculated as appropriate for each outcome.
RESULTS: Of the initial 1,992 studies, 17 (involving 1,943 participants) met inclusion criteria. Unstented patients were significantly more likely to have an unplanned medical visit compared to those who received a post-ureteroscopy stent (OR 1.63, 95% CI 1.15-2.30). Unstented patients had shorter operative time (WMD -3.19 minutes, 95% CI -5.64 to -0.74) and were less likely to experience dysuria (RR 0.39, 95% CI 0.25-0.62). They were also less likely to experience postoperative infection (OR 0.89, 95% CI 0.59-1.33) and pain (OR 0.64, 95% CI 0.39-1.05), although these results were not significant.
CONCLUSIONS: Stent omission is associated with an increased risk of unplanned medical visits, despite reduced symptoms compared to stented patients. Patients and physicians should weigh these tradeoffs when considering post-ureteroscopy stent placement.