📃 Paper Title: Ureteral stent versus no ureteral stent for ureteroscopy in the management of renal and ureteral calculi
🧍 Author: Maria Ordonez
🕒 Year: 2019
📚 Journal: Cochrane Database of Systematic Reviews
🌎 Country: USA
ㅤContext to the study:
Can you tell me about a study that showed no benefit to ureteral stent insertion compared to no stent insertion after uncomplicated ureteroscopy?
ㅤ✅ Take-home message of study:
The insertion of ureteral stent after uncomplicated ureteroscopy was associated with:
Increased post-operative pain at day 4 to 30, but no difference at day 0 or 1-4
Reduced unplanned visits to emergency or urgent care (21 fewer per 1000), but this did not reach statistical significance
No benefit in terms of need for secondary intervention
...when compared to not inserting a ureteral stent, but these were of low level certainty of evidence
ㅤ Systematic review and meta-analysis
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Study participants:
23 RCTs; 2275 patients
Inclusion criteria:
Randomised controlled trials in which participants underwent uncomplicated ureteroscopy with postoperative placement of a ureteral stent versus no ureteral stent
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Key study outcomes:
Unplanned return visit to emergency or urgent care department:
16 RCTs with 1970 participants; very low CoE
21 fewer episodes /1000 patients in those undergoing stent insertion (RR 0.69) compared to no stent insertion, but not statistically significant (95CI 0.4 to 1.2; p=0.2)
Post-operative discomfort (visual analogue scale):
Day 0: no difference between two groups (4 RCTs)
Day 1 to 3: no difference between two groups (8 RCTs)
Day 4 to 30: greater in stent patients compared to no stent insertion (standardised mean difference 0.62) (8 RCTs) (95% CI 0.08 to 1.16; p=0.02)
Need for secondary intervention (stent placement or exchange, percutaneous nephrostomy placement, secondary ureteroscopy)
No significant difference (RR 1.15)
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Study Limitations:
The certainty of evidence was judged to be "very low" for the outcomes of unplanned return to emergency care and post-op pain at day 4 to 30 due to methodological limitations of the included studies
The included studies did not have a universally applied definition of "uncomplicated" ureteroscopy
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