Editorial Comment to Impact of differential ureteral stent diameters on clinical outcomes after ureteroscopy intracorporeal lithotripsy: A systematic review and meta‐analysis

Abstract

Since ureteroscopy became the most utilized modality for treatment of urolithiasis in many countries, despite the diversity, the use of ureteral stents has been expanding due to the increased number of ureteroscopy patients worldwide. Ureteral stents are beneficial to preserve ureteral function and retain ureteral patency after the procedures; however, there are some issues regarding unfavorable symptoms, as well as the risks for encrustation, migration and infection with indwelling stents. In the current study, Wu et al. carried out a systematic review and meta-analysis investigating the influence of ureteral stent diameters on urinary tract symptoms, evaluated by the Ureteral Stent Related Symptoms Questionnaire. They compared the 4.7–5-Fr with 6-Fr diameter stents, and found that the smaller stents had better outcomes evaluated by the Ureteral Stent Related Symptoms Questionnaire pain and urinary symptom scores. In contrast, they were more likely to cause migration than the larger stents. Impressively, the seven randomized controlled trials had good quality with low risks of biases and were carried out in entirely different countries across the world. Most of them were also recent trials reported within 4 years, which means there has been high clinical interest and unmet needs toward stent-related problems among urologists. Sali and Joshi summarized several factors to improve unfavorable stent effects, such as material and composition, diameter, length, and shape. Aside from the smaller diameter, a silicone-made, spiral-shape and customized-length stent might be more beneficial to tolerate stent-related discomfort. Unfortunately, no best practice regarding the type of stents exists; therefore, the recent rise of research opportunities for ureteral stents could facilitate solving this issue.