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Role of pre-operative ureteral stent on outcomes of retrograde intra-renal surgery (RIRS): systematic review and meta-analysis of 3831 patients and comparison of Asian and non-Asian cohorts

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Abstract

Purpose

To evaluate the outcomes of pre-stented (PS) versus non-pre-stented (NPS) patients who have undergone retrograde intrarenal surgery (RIRS) for renal calculi with subgroup analysis of Asian and non-Asian cohorts.

Methods

Protocol is registered in PROSPERO, CRD42021261123. Eligible studies identified from four electronic databases. Meta-analysis was done to enumerate the outcomes of RIRS in between PS and NPS. Secondary sub-analysis was done to look for differences in outcomes in Asian and non-Asian cohorts.

Results

Fourteen studies involving 3831 patients (4 prospective, 10 retrospective studies) were included. PS patients experienced higher success rates of ureteral access sheath (UAS) insertion than NPS (RR 1.09, 95% CI 1.05–1.13, p < 0.00001). PS patients had lower risk of ureteral injuries from UAS placement (RR 0.69, 95% CI 0.50–0.96, p = 0.03). No significant differences in intra- and postoperative complications between two groups were found. Stone-free rate (SFR) outcomes for residual fragment (RF) cut-off of < 1 mm and < 4 mm favoured the PS patients (RR 1.10, 95% CI 1.04–1.17, p = 0.002 for < 4 mm, RR1.10, 95% CI 1.02–1.19, p = 0.02 for < 1 mm). In the subgroup analysis, PS Asian patients had similar SFR as NPS patients for SFR(< 4 mm) but non-Asian population showed better outcomes in the PS patients for SFR(< 4 mm) (RR 1.31, 95% CI 1.13–1.52, p = 0.0005).

Conclusions

This meta-analysis suggests that pre-stenting results in a higher success for UAS placement, minimising intraoperative ureteric injury, with higher overall SFR for any RF cut-off in PS cohorts. In non-Asian cohort, significant differences occurred at SFR < 4 mm but not for SFR < 1 mm. No difference was seen in our Asian cohort for any SFR cut-off in both PS and NPS patients.

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Abbreviations

CI:

Confidence intervals

MD:

Mean difference

mm:

Millimeters

NPS:

Non-pre-stented

PS:

Pre-stented

RF:

Residual fragments

RIRS:

Retrograde intra-renal surgery

RR:

Risk ratios

SFR:

Stone-free rates

UAS:

Ureteral access sheath

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Acknowledgements

We are grateful for the useful insights and expertise provided by the Team of worldwide endourological researchers (TOWER)

Author information

Authors and Affiliations

  1. Department of Urology, National University Hospital, National University Health System, Singapore, Singapore

    Y. X. T. Law

  2. S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China

    J. Y. C. Teoh & E. O. T. Chan

  3. Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica Delle Marche, Ancona, Italy

    D. Castellani, C. Giulioni & S. Scarcella

  4. Department of Urology, Singapore General Hospital, Singapore, Singapore

    E. J. Lim

  5. Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil

    M. Wroclawski

  6. BP-a Beneficência Portuguesa de São Paulo, São Paulo, Brazil

    M. Wroclawski

  7. Department of Urology, San Donato Hospital, Arezzo, Italy

    G. M. Pirola & M. Gubbioti

  8. Department of Urology, A.O.U.I. Verona University, Verona, Italy

    E. Rubilotta

  9. Department of Urologic Sciences, University of British Columbia, Vancouver, Canada

    B. H. Chew

  10. Service d’Urologie, Sorbonne Université, Paris, France

    O. Traxer

  11. Service d’Urologie, AP-HP, Hôpital Tenon, Paris, France

    O. Traxer

  12. Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK

    B. K. Somani

  13. Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore

    V. Gauhar

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  1. Y. X. T. Law
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Contributions

GV and LYXT conceived the study. LYXT, TJYC, CD, and GV designed the study protocol. LYXT led the development of the manuscript. LYXT performed statistics. LYXT, TJYC, CD, LEJ, CEOT, WM, PGM, GC, RE, GM, SS and GV performed data extraction and analysis. CD, TJYC, CBH, TO, SBK and GV reviewed the paper for critical intellectual content. All authors participated in manuscript writing, review, and approval of the final version of the manuscript for submission.

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Correspondence to Y. X. T. Law.

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Law, Y.X.T., Teoh, J.Y.C., Castellani, D. et al. Role of pre-operative ureteral stent on outcomes of retrograde intra-renal surgery (RIRS): systematic review and meta-analysis of 3831 patients and comparison of Asian and non-Asian cohorts. World J Urol 40, 1377–1389 (2022). https://doi.org/10.1007/s00345-022-03935-2

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