The influence of pre-stenting and drugs on the outcomes of ureteroscopy for kidney and ureteral stone disease: a systematic review and meta-analysis by the EAU Section of Endourology

Introduction: Ureteroscopy serves as a minimally invasive surgical treatment option for ureteral and kidney stones but is not without technical challenges. Pre-stenting and medical therapies, such as alpha-blockers, may improve outcomes by facilitating ureteral access sheath placements and reducing complications. This systematic review and meta-analysis aimed to evaluate the effects of pre-stenting and preoperative pharmacological agents on ureteroscopy outcomes. Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. A comprehensive literature search was performed across multiple databases, identifying randomized controlled trials comparing ureteroscopy outcomes with and without pre-stenting and pre-ureteroscopy medical therapy. Primary outcomes included failure rates in accessing the upper urinary tract, while secondary outcomes encompassed operative times, complications, and stone-free rates. Results: The analysis included 16 randomized controlled trials, revealing that pre-stenting and medical therapy significantly reduced failure rates (Relative Ratio 0.44, 95% CI 0.33-0.59, p < 0.001) and operative times (Mean Difference -10.81 min, 95% CI -13.45 to -8.18, p < 0.001). Additionally, there was a higher stone-free rates, lower need for postoperative stenting and fewer complications associated with preoperative ureteral dilation interventions. Conclusion: Preoperative alpha blockers enhance ureteroscopy success and reduces complications. The evidence supports their use before ureteroscopy for renal and ureteral stones, improving patient outcomes and procedural efficiency. Patients pre-stented for any reason demonstrated significantly improved ureteroscopic access and stone-free rates.