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Stenting Before Lithotripsy Yields Mixed Results

The authors write that more study is needed to clarify this issue

A systematic review and meta-analysis published recently in the Journal of Urology found that stenting before extracorporeal shock wave lithotripsy (ESWL) may result in lower rates of Steinstrasse compared to in situ ESWL, but it did not benefit stone-free ratio or auxiliary treatment. It also resulted in more lower urinary tract symptoms (LUTS).

Although ESWL has revolutionized the management of urinary calculi since its introduction in 1980, the routine use of stenting before ESWL for upper urinary tract calculi is controversial. Fragments that obstruct the ureter can lead to post-ESWL complications, and fragments that lodge in the ureter form Steinstrasse. Stenting is invasive, can cause discomfort, and some research has shown that D-J stenting does not improve ESWL results. With the current study, the authors performed a systematic review and meta-analysis to assess pre-ESWL stenting.

A search of PubMed (from 1980 to December 2010), EMBASE (from 1980 to December 2010), the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews yielded eight studies with a total of 876 patients (453 in the stented group and 423 in the stentless group). All patients were treated with ESWL and were divided into stented and stentless. Each group had three subgroups: renal stone; ureteral stone; and renal or ureteral stone groups. Outcomes and complications were measured, including stone-free rate, Steinstrasse, LUTS, hematuria, fever, urinary tract infection (UTI), pain and need for analgesia, nausea and vomiting, and auxiliary treatment. Patients were followed for at least three months. Stone clearance was defined as the absence of residual stones by plain radiographic film, ultrasonography, or excretory urography after ESWL.

The authors found no significant difference in stone-free rate, hematuria, fever, UTI, pain and analgesia, auxiliary treatment, or nausea and vomiting between groups. Only one study found a significant difference in the incidence of Steinstrasse between groups. The incidence of LUTS was significantly higher in the stented group.

The authors conclude that, "Whether ureteral stents should be used in ESWL remains controversial. More high quality, well designed, randomized, controlled multicenter trials that are adequately powered are needed to address this issue."

Source: Pengfei S, Min J, Jie Y, et al. 2011. Use of ureteral stent in extracorporeal shock wave lithotripsy for upper urinary calculi: a systematic review and meta-analysis. Journal of Urology 186:1328-1335.