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

Maria Ordonez, Michael Borofsky, Caitlin Bakker, Shreyas Gandhi, Philipp Dahm

Research output: Contribution to conferenceAbstract

Abstract

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 We searched multiple data sources for published and unpublished randomized controlled trials (RCTs) in any language.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.
Original languageEnglish (US)
Pagese890
DOIs
StatePublished - Apr 1 2018
EventCanadian Urological Association - Halifax, Canada
Duration: Jun 23 2018Jun 26 2018

Conference

ConferenceCanadian Urological Association
CountryCanada
CityHalifax
Period6/23/186/26/18

Fingerprint

Stents
Meta-Analysis
Confidence Intervals
Odds Ratio
Operating Rooms
Pathologic Constriction
Software
Ureteral Calculi
Ureteroscopy
Kidney Calculi
Information Storage and Retrieval
Urinary Tract Infections
Language
Randomized Controlled Trials

Cite this

Ordonez, M., Borofsky, M., Bakker, C., Gandhi, S., & Dahm, P. (2018). To Stent or Not to Stent: A Cochrane Review and Meta-Analysis. e890. Abstract from Canadian Urological Association, Halifax, Canada. https://doi.org/10.1016/j.juro.2018.02.2148

To Stent or Not to Stent: A Cochrane Review and Meta-Analysis. / Ordonez, Maria; Borofsky, Michael; Bakker, Caitlin; Gandhi, Shreyas; Dahm, Philipp.

2018. e890 Abstract from Canadian Urological Association, Halifax, Canada.

Research output: Contribution to conferenceAbstract

Ordonez, M, Borofsky, M, Bakker, C, Gandhi, S & Dahm, P 2018, 'To Stent or Not to Stent: A Cochrane Review and Meta-Analysis' Canadian Urological Association, Halifax, Canada, 6/23/18 - 6/26/18, pp. e890. https://doi.org/10.1016/j.juro.2018.02.2148
Ordonez M, Borofsky M, Bakker C, Gandhi S, Dahm P. To Stent or Not to Stent: A Cochrane Review and Meta-Analysis. 2018. Abstract from Canadian Urological Association, Halifax, Canada. https://doi.org/10.1016/j.juro.2018.02.2148
Ordonez, Maria ; Borofsky, Michael ; Bakker, Caitlin ; Gandhi, Shreyas ; Dahm, Philipp. / To Stent or Not to Stent: A Cochrane Review and Meta-Analysis. Abstract from Canadian Urological Association, Halifax, Canada.
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abstract = "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.",
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N2 - 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.

AB - 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.

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