The influence of pre-stenting and drugs on the outcomes of ureteroscopy for kidney and ureteral stone disease: a systematic review and meta-analysis by the EAU Section of Endourology
Steffi Kar Kei Yuen, Daniele Castellani, Theodoros Tokas, Giacomo Maria Pirola, Carlo Giulioni, Jia‐Lun Kwok, Mohamed Amine Lakmichi, Takafumi Yanagisawa, Amelia Pietropaolo, Thomas Herrmann, Bhaskar Somani, Vineet Gauhar
Abstract
INTRODUCTION: Ureteroscopy serves as a minimally invasive surgical treatment option for ureteral and kidney stones but is not without technical challenges. Pre-stenting and medical therapies, such as alpha-blockers, may improve outcomes by facilitating ureteral access sheath placements and reducing complications. This systematic review and meta-analysis aimed to evaluate the effects of pre-stenting and preoperative pharmacological agents on ureteroscopy outcomes. METHODS: We conducted a systematic review and meta-analysis following PRISMA guidelines. A comprehensive literature search was performed across multiple databases, identifying randomized controlled trials comparing ureteroscopy outcomes with and without pre-stenting and pre-ureteroscopy medical therapy. Primary outcomes included failure rates in accessing the upper urinary tract, while secondary outcomes encompassed operative times, complications, and stone-free rates. RESULTS: The analysis included 16 randomized controlled trials, revealing that pre-stenting and medical therapy significantly reduced failure rates (Relative Ratio 0.44, 95% CI 0.33-0.59, p < 0.001) and operative times (Mean Difference -10.81 min, 95% CI -13.45 to -8.18, p < 0.001). Additionally, there was a higher stone-free rates, lower need for postoperative stenting and fewer complications associated with preoperative ureteral dilation interventions. CONCLUSION: Preoperative alpha blockers enhance ureteroscopy success and reduces complications. The evidence supports their use before ureteroscopy for renal and ureteral stones, improving patient outcomes and procedural efficiency. Patients pre-stented for any reason demonstrated significantly improved ureteroscopic access and stone-free rates.