Is Stone Diameter a Variable in the Decision Process of Placing Or Not a Ureteral Stent

Is stone diameter a variable in the decision process of placing or not a ureteral stent in patients undergoing uncomplicated ureterorenoscopy with intracorporeal lithotripsy?

INTRODUCTION

A number of randomized trials and meta-analysis in patients who were undergoing ureteroscopic stone removal investigated the effects of placing a stent at the end of the procedure on complication rates. But, no one investigates if the diameter of the stone can play a role in term of operative time or complication rates and if we should consider it as a variable in the decision process of placing or not a ureteral stent.

MATERIALS AND METHODS

Studies were identified by searching electronic databases and scanning reference lists of articles. A bibliographic search covering the period from January 1990 to March 2012 was conducted in PubMed, MEDLINE and EMBASE. This analysis is based on the fifteen remaining studies that fulfilled the predefined inclusion criteria. All statistical evaluations were performed using SAS version 9.2. and by RevMan 5.0. The α level of 0.05 was considered statistically significant and all statistical tests were two tailed.

RESULTS

A total of 1416 participants were included. All the studies were published after 2000. Mean stone diameter ranges between 5,3 and 13,3 mm in the non stented group and between 6,26 and 13,28 mm in the stented group. Meta-analysis showed that stone diameter was not statistically different for stent or no stent subgroups, whereas surgical operative time was shorter for the non-stent subgroup. The effect of stone diameter did not influenced fever, haematuria, unplanned medical visits after surgery and urinary tract infections, irrespectively if patients operated with or without stent where grouped or considered separately.

DISCUSSION

The innovation of this meta-analysis is to investigate the role of stone diameter in order to understand if it can play a role in determining post-operative complications and operative time by considering all the patients together and in the two groups separately.

We could hypnotize that bigger stone need a higher operative time and an associated higher complications rates for haematuria, urinary tract infections, fever and unplanned medical visits.

CONCLUSION

In the pre-operatory assessment, we will not consider stone diameter as a variable in the decision process of placing or not a ureteral stent in patients undergoing uncomplicated ureterorenoscopy with intracorporeal lithotripsy.