To Stent or Not to Stent: A Cochrane Review and Meta-Analysis

Introduction: The role of ureteral stent placement following uncomplicated ureteroscopy for ureteral and renal calculi remains controversial. We performed this review to better understand the tradeoffs of stenting vs. not stenting to inform clinical decision-making.

Methods: We conducted a Cochrane review based on published a priori protocol. We searched multiple data sources for published and unpublished randomized controlled trials (RCTs) in any language. Review outcomes were included unplanned return visits, need for secondary interventions, operating room (OR) time, urinary tract infections (UTIs), and ureteral stricture rates. We completed title/abstract and full-text screening in duplicate using Covidence software. Based on a priori published protocol, we performed meta-analysis using RevMan 5.3 software using random effect models and rated the quality of evidence using GRADE.

Results: We screened the titles/abstracts of 3459 references and subsequently 32 full-text studies, of which ultimately 24 met our inclusion criteria. We found that stenting may not change the rate of secondary interventions with a risk ratio (RR) of 0.65 (95% confidence interval [CI] 0.24–1.77; low-quality evidence); this corresponds to six fewer (14 fewer to 14 more) per 1000 patients. Stenting may also not change the rate of return to the hospital, with a RR of 0.77 (95% CI 0.48–1.24; low-quality evidence); this corresponds to 14 fewer (95% CI 33 fewer to 15 more) per 1000 patients. Based on moderate-quality evidence, OR time is likely longer by a mean difference of 4.0 minutes (95% CI 2.2-5.9). Stenting may also not impact strictures rates (RR 0.88; 95% CI 0.30–2.59; low-quality evidence); this corresponds to one fewer (6 fewer to 13 more) per 1000.