The Value of Ureteral Stent Placement before Extracorporeal Shock Wave Lithotripsy: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 SHAO Yongsheng , HUANG Xiang

The Second People’s Hospital of Ya’an City, Ya’an 625000, China;

Corresponding author：

SHAO Yongsheng, Email: 496273968@qq.com

Keywords：

Extracorporeal shock wave lithotripsy; Ureteral stent; Ureteral calculi; Randomized controlled trial; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20100586

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To evaluate the value of Ureteral Stent Placement before Extracorporeal Shock Wave Lithotripsy (ESWL).
Methods 　We searched the Cochrane Central Register of Controlled Trials (Issue 4, 2010), MEDLINE (OVID 1950 to April 2010), EMbase (1979 to April 2010), CBM (1978 to April 2010), CNKI (1979 to April 2010), and VIP (1989 to April 2010), and manually searched journals as well. All the randomized controlled trials (RCTs) of treating ureteral stone with ESWL after stent placement were included. We evaluated the risk of the bias of the included RCTs according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The Cochrane Collaboration’s software RevMan 5.0 was used for meta-analysis.
Results 　Three RCTs with C-level evidence involving 319 ureteral stone patients were identified. The results of meta-analyses showed that: a) Effect of treatment: The ureteral stent placement before ESWL did not take better effects in aspects of the complete clearance rate (WMD= 1.10, 95%CI 0.87 to 1.38), the quantity of lithotripsy (WMD= 0.43, 95%CI – 1.05 to 0.19), the frequency of shock wave (WMD= 0.00, 95%CI – 0.25 to 0.25), and the power of shock wave (WMD= 0.20, 95%CI – 0.05 to 0.46); and b) Postoperative complications: The ureteral stent placement were prone to cause dysuria (RR= 2.30, 95%CI 1.62 to 3.26), microscopic hematuria (RR= 2.66, 95%CI 1.97 to 3.58), gross hematuria (RR= 6.50, 95%CI 1.50 to 28.15), pyuria (RR= 1.78, 95%CI 1.44 to 2.21), positive urine culture (RR= 2.13, 95%CI 1.71 to 2.64), and suprapubic pain (RR= 3.10, 95%CI 1.59 to 6.04).
Conclusions 　Ureteral stent placement before ESWL is inadvisable. Multi-factors which lead to bias affected the authenticity of our review, such as low-quality and small amount of RCTs. Further large-scale trials are required.

Citation： SHAO Yongsheng,HUANG Xiang. The Value of Ureteral Stent Placement before Extracorporeal Shock Wave Lithotripsy: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2010, 10(11): 1293-1301. doi: 10.7507/1672-2531.20100586 Copy

1.	Chaussy CH, Brendel W, Schmiedt. Extracorporeally induced destruction of kidney stones by shock waves. The Lancet, 1980, 316(8207): 1265-1268.
2.	Gomha MA, Sheir KZ, Showky S, et al. Can we inprove the prediction of stone-free status after extracorporeal shock wave lithotripsy for ureteral stones? A neural network or statistical model? The Journal of Urology, 2004, 172: 175-179.
3.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration, 2009, Available from: www.cochrane-handbook.org.
4.	EI-Assmy A, EI-Nahas AR, Sheir KZ. Is Pre-Shock Wave Lithotripsy Stenting Necessary for Ureteral Stones With Moderate or Severe Hydronephrosis? The Journal of Urology, 2006, 176: 2059-2062.
5.	Ghoneim IA, EI-Ghoneimy MN, EI- Naggar AE, et al. Extracorporeal Shock Wave Lithotripsy in Impacted Upper Ureteral Stones: A Prospective Randomized Comparison Between Stented and Non-stented Techniques. Urology, 2010, 75: 45-50.
6.	虎华静, 邓发凯, 吴建军, 等. 双“J”管在体外冲击波碎石治疗输尿管结石中的应用. 现代预防医学, 2007, 34(7): 1384-1385.
7.	那彦群, 郭震华. 实用泌尿外科学. 第1版. 北京: 人民卫生出版社, 2009: 243-247.
8.	Morgentaler A, Bridge SS, Dretler SP. Management of the impacted ureteral calculus. The Journal of Urology, 1999, 143: 263-266.
9.	Cass AS. Do upper ureteral stones need to be manipulated into the kidney before extracorporeal shock wave lithotripsy. The Journal of Urology, 1992, 147: 349-351.
10.	Al-Awadi KA, Abdul Halim H, Kehinde EO, et al. Steinstrasse: a comparison of incidence with and without J stenting and the effect of J stenting on subsequent management. BJU International, 1999, 84(6): 618-621.
11.	Argyropoulos AN, Tolley DA. Ureteric stents compromise stone clearance after shockwave lithotripsy for ureteric stones: results of a matched-pair analysis. BJU International, 2008, 103: 76-80.
12.	Chandhoke PS, Barqawi AZ, Wernecke C, et al. A randomized outcomes trial of ureteral stents for extracorporeal shock wave lithotripsy of solitary kidney or proximal ureteral stones. The Journal of Urology, 2002, 167: 1981-1983.
13.	Hendrikx AJM, Bierkens AF, Oosterhof GON, et al. Treatment of Proximal and Midureteral Calculi: A Randomized Trial of In Situ and Pushback Extracorporeal Lithotripsy. Journal of Endourology, 1990, 4(4):353-359.
14.	Mokhmalji H, Braun PM, Portillo FJ, et al. Percutaneous nephrostomy versus ureteral stents for diversion of hydronephrosis caused by stones:a prospective, randomized clinical trial. The Journal of Urology, 2000, 165: 1088-1092.
15.	Haleblian G, Kijvikai K, Rosette JDL, et al. Ureteral Stenting and Urinary Stone Management: A Systematic Review. The Journal of Urology, 2008, 179: 424-430.
16.	Joshi HB, Newns N, Stainthorpe A, et al. Ureteral stent symptom questionnaire development and validation of a multidimensional quality of life measure. The Journal of Urology, 2003, 169: 1060-1064.

1. Chaussy CH, Brendel W, Schmiedt. Extracorporeally induced destruction of kidney stones by shock waves. The Lancet, 1980, 316(8207): 1265-1268.
2. Gomha MA, Sheir KZ, Showky S, et al. Can we inprove the prediction of stone-free status after extracorporeal shock wave lithotripsy for ureteral stones? A neural network or statistical model? The Journal of Urology, 2004, 172: 175-179.
3. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration, 2009, Available from: www.cochrane-handbook.org.
4. EI-Assmy A, EI-Nahas AR, Sheir KZ. Is Pre-Shock Wave Lithotripsy Stenting Necessary for Ureteral Stones With Moderate or Severe Hydronephrosis? The Journal of Urology, 2006, 176: 2059-2062.
5. Ghoneim IA, EI-Ghoneimy MN, EI- Naggar AE, et al. Extracorporeal Shock Wave Lithotripsy in Impacted Upper Ureteral Stones: A Prospective Randomized Comparison Between Stented and Non-stented Techniques. Urology, 2010, 75: 45-50.
6. 虎华静, 邓发凯, 吴建军, 等. 双“J”管在体外冲击波碎石治疗输尿管结石中的应用. 现代预防医学, 2007, 34(7): 1384-1385.
7. 那彦群, 郭震华. 实用泌尿外科学. 第1版. 北京: 人民卫生出版社, 2009: 243-247.
8. Morgentaler A, Bridge SS, Dretler SP. Management of the impacted ureteral calculus. The Journal of Urology, 1999, 143: 263-266.
9. Cass AS. Do upper ureteral stones need to be manipulated into the kidney before extracorporeal shock wave lithotripsy. The Journal of Urology, 1992, 147: 349-351.
10. Al-Awadi KA, Abdul Halim H, Kehinde EO, et al. Steinstrasse: a comparison of incidence with and without J stenting and the effect of J stenting on subsequent management. BJU International, 1999, 84(6): 618-621.
11. Argyropoulos AN, Tolley DA. Ureteric stents compromise stone clearance after shockwave lithotripsy for ureteric stones: results of a matched-pair analysis. BJU International, 2008, 103: 76-80.
12. Chandhoke PS, Barqawi AZ, Wernecke C, et al. A randomized outcomes trial of ureteral stents for extracorporeal shock wave lithotripsy of solitary kidney or proximal ureteral stones. The Journal of Urology, 2002, 167: 1981-1983.
13. Hendrikx AJM, Bierkens AF, Oosterhof GON, et al. Treatment of Proximal and Midureteral Calculi: A Randomized Trial of In Situ and Pushback Extracorporeal Lithotripsy. Journal of Endourology, 1990, 4(4):353-359.
14. Mokhmalji H, Braun PM, Portillo FJ, et al. Percutaneous nephrostomy versus ureteral stents for diversion of hydronephrosis caused by stones:a prospective, randomized clinical trial. The Journal of Urology, 2000, 165: 1088-1092.
15. Haleblian G, Kijvikai K, Rosette JDL, et al. Ureteral Stenting and Urinary Stone Management: A Systematic Review. The Journal of Urology, 2008, 179: 424-430.
16. Joshi HB, Newns N, Stainthorpe A, et al. Ureteral stent symptom questionnaire development and validation of a multidimensional quality of life measure. The Journal of Urology, 2003, 169: 1060-1064.

Chinese Journal of Evidence-Based Medicine

The Value of Ureteral Stent Placement before Extracorporeal Shock Wave Lithotripsy: A Meta-analysis

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