How can "evidence-based medicine" improve symptoms related to ureteral stent tubes? Complete ureteral stent placement may be a better solution

The ureteral stent is one of the most widely used instruments in urology, which drains urine and protects kidney function
.
However, patients with indwelling ureteral stent tubes are prone to stent tube discomfort such as bladder irritation
.
Therefore, how to improve the symptoms associated with ureteral stent tubes is worth discussing
.

The distal coil of the double J ureteral stent tube is thought to be the main cause of stent canal-related symptoms, and complete ureteral stent tube placement (CIU-SP) appears to alleviate these symptoms
.
This systematic review and meta-analysis aimed to assess the safety and efficacy
of CIU-SP compared to conventional stenting (C-SP).

Based on the Systematic Review and Meta-Analysis Priority Report Entry (PRISMA) statement, the investigators used the following subject terms ((complete intraureteral stent) OR (suture stent)) AND (symptom OR pain) AND (randomized OR randomised) for PubMed, Embase, Web of A systematic and comprehensive search
of relevant English literature published before December 2021 in the three databases of Science was conducted.

The meta-analysis ultimately included six randomised controlled trials, all of which reported short-term (week 1~2) symptom outcomes
after ureteral stenting placement.

Urinary symptoms showed that CIU-SP significantly improved stent tube-related symptoms
.
Patients in the CIU-SP group had lower urinary symptom field scores on the Ureteral Stent Symptom Scale (USSQ) compared with the C-SP group (MD -5.
13; 95% CI -5.
82, -4.
44).

Fig.
1 Forest plot of USSQ urinary symptom field score in two groups

At the same time, CIU-SP significantly reduced the patient's postoperative pain
.
Patients in the CIU-SP group scored lower in the USSQ pain domain (MD -4.
21; 95% CI -5.
25, -3.
17) and lower pain visual score (VAS) (MD -1.
93; 95% CI -2.
17, -1.
69)
compared with the C-SP group.
In addition, patients with CIU-SP were less likely to experience pain (RR = 0.
78; 95% CI 0.
67, 0.
91).

There was no significant difference
in USSQ total health and work performance scores between the two groups.

Fig.
2 Forest plot of pain domain scores in the two groups

In terms of safety, there was no significant difference in serious adverse events between the CIU-SP group and the C-SP group, and the probability of developing Clavien-Dindo classified ≥ grade 2 complications was low
in both groups.

Table 1 Comparison of serious adverse events in the two groups

Compared with C-SP, CIU-SP significantly reduces stent-associated urinary tract symptoms and pain
.
The available evidence suggests that CIU-SP can be applied in clinical practice (at least in cases of short-term indwelling stents after uncomplicated ureteroscopic lithotripsy) and is worth generalizing
.

References:

Ho CH, Liu SP, Wang CW, et al.
Complete intraureteral stent placement reduces stent-related symptoms: Systemic review and meta-analysis.
J Formos Med Assoc.
2022 Nov; 121(11):2308-2316.