Comparison of different segmental metal ureteral stents as maintenance therapy across different years in ureteral stricture management: a systematic review and meta-analysis.

BACKGROUND

Ureteral stent placement is a common treatment for relieving hydronephrosis due to ureteral strictures. Recently, segmental metal ureteral stents (MUSs) have emerged as a promising option. However, the efficacy and complications of different segmental MUSs remain controversial.

OBJECTIVE

To evaluate and compare the efficacy and safety of different segmental MUSs as the long-term maintenance therapy across different years for ureteral strictures caused by various etiologies.

METHODS

A systematic search of databases, including PubMed, Web of Science, and Embase, was conducted to identify studies that employed segmental MUSs. The primary success was defined as the absence of complications necessitating further intervention following successful stent placement and continued patency. The weighted pooled primary success rates of different segmental MUSs were calculated using R over three duration intervals: less than 1, 1-2, and more than 2 years.

RESULTS

A total of 31 studies, comprising 1660 cases, were included in the meta-analysis. The weighted pooled primary success rates for segmental MUSs were 73% (95% CI [70%, 77%], I2  = 18%) for durations of less than 1 year, 66% (95% CI [56%, 75%], I2  = 90%) for 1-2 years, and 39% (95% CI [23%, 55%], I2  = 90%) for more than 2 years. The variation in stent types was identified as a significant source of heterogeneity. Notably, the Allium stent exhibited a primary success rate of 81% (95% CI [75%, 87%], I2  = 63%) for the 1-2-year period, and 65% (95% CI [54%, 76%], I2  = 0%) for durations exceeding 2 years, significantly outperforming both the Uventa (1-2 year: 51%; >2 year: 23%) and Memokath (1-2 year: 53%; >2 year: 23%) ( P < 0.001). Moreover, covered stents demonstrated significantly greater efficacy than uncovered stents for 1-2 years (75% vs. 53%; P = 0.01). Complications leading to stent failure primarily included obstruction, migration, encrustation, and urinary tract infection.

CONCLUSION

The safety and efficacy of various segmental MUSs as long-term maintenance therapy for ureteral strictures vary significantly. The Allium stent showing a marked advantage over other stents, making it a preferred choice for long-term management.