The Effect of Ureteral Stent Placement on Post-ureteroscopy Complications: A Meta-analysis

Objectives: To determine, by systematic review and meta-analysis of all randomized controlled trials examining ureteral stent placement after ureteroscopy, whether the presence or absence of a stent was associated with postoperative complications. Methods: All randomized clinical trials of ureteral stent placement after ureteroscopy were identified with PubMed. The primary outcome was the occurrence of a urologic complication, defined as secondary procedure, emergency department evaluation, or hospital admission. The complication rates were compared between the stented (treatment) and unstented (control) arms of each trial as a risk difference, pooled as a weighted average across all studies, using both fixed and random-effects models. Results: Ten trials were identified, with a total of 891 subjects. Patients undergoing ureteral stent placement after ureteroscopy had a 4% lower occurrence of urologic complications (95% confidence interval -10.1%, 1.8%). This difference, however, failed to reach statistical significance after accounting for heterogeneity in the data (P = 0.175). Conclusions: There is a slightly lower absolute risk of complication associated with the placement of a ureteral stent after ureteroscopy. However, meta-analysis of the present literature does not detect a significant difference in outcome between patients who undergo ureteral stent placement after ureteroscopy and those who do not.