Ureteral stents cannot decrease the incidence of ureteroileal anastomotic stricture and leakage: A systematic review...

Area of Science:

• Urology
• Surgical Oncology
• Medical Engineering

Background:

• Ileal conduit and orthotopic neobladder are common urinary diversions post-radical cystectomy.
• Ureteral stenting is frequently used but its benefit in preventing ureteroileal anastomosis stricture (UIAS) and leakage (UIAL) is debated.

Purpose of the Study:

• To evaluate the efficacy of ureteral stents in preventing UIAS and UIAL after ureteral anastomosis in urinary diversion procedures.

Main Methods:

• Systematic literature search of PubMed, Embase, and Cochrane Library up to June 2020.
• Meta-analysis of four cohort studies comparing stented and non-stented groups for UIAS and UIAL incidence.
• Meta-analysis of single proportion from eleven studies reporting UIAS and UIAL events.

Main Results:

• Comparative meta-analysis showed a higher, though not statistically significant, incidence of UIAS in the stented group (OR: 1.64; P=0.12).
• No significant difference in UIAL incidence was observed between stented and non-stented groups.
• Single proportion meta-analysis indicated UIAS incidence of 7% in stented vs. 3% in non-stented groups; UIAL was 1% in stented vs. 2% in non-stented groups.

Conclusions:

• Ureteral stenting of the ureteroileal anastomosis is associated with a higher incidence of UIAS.
• Current evidence does not support the routine use of ureteral stents to prevent UIAL after urinary diversion.