📃 Paper Title: Outcomes of stenting after ureteroscopy: a systematic review and meta-analysis
🧍 Author: Ghulam Nabi
🕒 Year: 2007
📚 Journal: British Medical Journal
🌎 Country: United Kingdom
ㅤContext to the study:
Can you summarise the current literature regarding the benefits and adverse events of stenting after uncomplicated ureteroscopy?
ㅤ✅ Take-home message of study:
Stenting after ureteroscopy is associated with greater incidence of frequency/urgency and dysuria compared to no stenting.
No evidence to suggest increased usage of postop analgesia, UTI, stone clearance rates and ureteric stricture development for stenting after ureteroscopy compared to no stenting.
BUT marked heterogeneity and poor quality of reporting of the included trials
ㅤ Systematic review and meta-analysis
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Study participants:
Participants:
9 RCTs comparing stenting with no stenting after uncomplicated ureteroscopy.
Participants (n=831 total): adults with a clinical diagnosis of ureteric stone who required intervention or who were undergoing diagnostic or therapeutic ureteroscopy for upper tract transitional cell carcinoma and had at least one of the predetermined outcomes of interest.
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Key study outcomes:
Outcomes of interest
Pain, need for analgesia, lower urinary tract symptoms, unplanned medical visits or admission, stent complications related to the stent, return to normal physical activities
LUTs risk ratios in stented compared to unstented groups
Frequency/urgency: 2.00 (1.11 to 3.62, p=0.02). Significant.
Dysuria: 2.25 (1.14 to 4.43, p=0.02). Significant.
Haematuria: 2.18 (0.72 to 6.61, p=0.17). Not significant.
However, heterogeneity was high (p>0.05, I2 between 70-100%).
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Study Limitations:
Risk of bias for selected trials not reported.
However, the authors stated the general quality of trials was poor. There was no evidence of allocation concealment and blinding in several studies.
Quality of evidence was not assessed, using a method such as GRADE analysis.
Marked heterogeneity amongst studies.
Lack of standardisation for outcome measures, length of trial, duration of stenting. Choice of measure was variable across studies for each outcome variable.
The p-values and I2 for the LUTs risk ratio was high.
Not all results were pooled for meta-analysis.
Criteria for uncomplicated ureteroscopy not defined
Subjective based on operating surgeon.
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