Timing of definitive stone management in acute obstructive urolithiasis: does early intervention improve outcomes? A meta-analysis.

PURPOSE: This meta-analysis evaluated whether the timing of definitive stone removal influences clinical outcomes in patients with obstructive or infection-associated urolithiasis, comparing early versus delayed intervention strategies.

METHODS

A systematic search of PubMed, Embase, and the Cochrane Library was performed through November 2025. Studies comparing early (≤ 72 h after presentation or drainage) and delayed (> 72 h) definitive procedures were included. Primary endpoints were postoperative infection and overall complications (Clavien–Dindo grade ≥ II); secondary outcomes comprised postoperative sepsis and readmission. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using random-effects models. Subgroup analyses were stratified by population type and definition of early timing, and sensitivity analyses were performed by sequential study exclusion. Publication bias was assessed using funnel plot symmetry and Peters’ test.

RESULTS

Ten studies encompassing 14,611 patients were included. Compared with delayed management, early intervention showed no significant difference in overall complication rates (RR = 1.28, 95% CI 0.92–1.79, I² = 0%). Similarly, risks of postoperative infection (RR = 0.86, 95% CI 0.29–2.58), readmission (RR = 1.10, 95% CI 0.78–1.55), and sepsis (RR = 0.88, 95% CI 0.43–1.79) were comparable. Subgroup analyses indicated that heterogeneity was mainly driven by the definition of “early” and clinical population (P = 0.0105). Procedures performed within 12–48 h after stabilization tended to yield a lower infection rate, whereas postponement beyond 48 h or until post-drainage offered no additional safety advantage. No significant publication bias was detected (Peters’ p > 0.05).

CONCLUSIONS

Definitive stone management within 24–72 h following clinical stabilization appears safe and does not increase postoperative morbidity relative to delayed surgery. These findings suggest that, in carefully selected and clinically stabilized patients, early definitive stone removal appears non-inferior to delayed management with respect to postoperative safety outcomes. Rather than advocating universal early intervention, our results support an individualized, physiology-guided approach to timing decisions.