The necessity of presetting ureteral stents before ureteroscopic lithotripsy: a Meta-analysis

Objective To systematically evaluate the necessity of presetting double-J stent before flexible ureteroscope lithotripsy. Methods Computer retrieved clinical studies on the effect of preoperative presetting double-J-catheter on flexible ureteroscope lithotripsy in PubMed, Cochrane Library, Embase, Scopus, Wan fang, CNKI and VIP databases were reviewed. The retrieval time was from the database construction to November 2018. All of the possible combinations of the following terms were used for the search: flexible ureteroscopic, preoperative, double J stent, and calculus. Two researchers independently conducted literature screening, quality evaluation and data extraction, and completed Meta analysis by using statistical software RevMan5.3. Results Thirty-two case-control trials and 14 randomized controlled trials were screened, with a total of 17 480 patients, including 6 211 patients in the experimental group and 11 269 patients in the control group. The results of meta-analysis showed that the experimental group was superior to the control group in term of the overall postoperative stone clearance rate (OR=1.69, 95%CI 1.37-2.08, P<0.05). In terms of postoperative kidney stone removal rate, the experimental group was superior to the control group (OR=1.67, 95%CI 1.41-1.99, P<0.05). In terms of the removal rate of ureteral calculi after surgery, there was no significant difference between the two groups (OR=1.71, 95%CI 0.91-3.20, P=0.10). The success rate of flexible ureteroscope access sheath implantation was higher in the experimental group (OR=5.77, 95%CI 3.32-10.31, P<0.05). The rate of passive usage balloon dilation in the control group was higher(OR=0.23, 95%CI 0.15-0.35, P<0.05). For the incidence of intraoperative complications, the experimental group was lower (OR=0.56, 95%CI 0.38-0.84, P=0.004). For the incidence of postoperative complications, the experimental group was also lower(OR=0.64, 95%CI 0.45-0.90, P=0.01). The operation time of the control group was longer(MD=-4.95, 95%CI -8.90--1.01, P=0.01). Conclusions Presetting double-J-catheter can improve the stone removal rate after flexible ureteroscope lithotripsy for the treatment of kidney stone, improve the success rate of flexible ureteroscope access sheath implantation, reduce the utilization rate of ureteral balloon dilator, reduce the incidence of intraoperative and postoperative complications, and shorten the operation time. Key words: Urinary calculus; Flexible ureteroscopic; Double J stent; Meta-analysis