SYSTEMATIC REVIEW article
Front. Surg.
Sec. Genitourinary Surgery and Interventions
Effects of Ureteral Stent Removal Using an Extraction String Following Ureteroscopic Lithotripsy: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Provisionally accepted
- 1The People's hospital of Yuhuan, Taizhou, China
- 2The Second People’s Hospital of Tongxiang, tongxiang, China
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Background: Ureteral stent removal using an extraction string after lithotripsy is gaining popularity, but current evidence on patient outcomes is limited. This meta-analysis aimed to evaluate pain and complications associated with string-based versus cystoscopic stent removal. Methods: A systematic search of PubMed, Web of Science, Embase, Cochrane Library, and Scopus was conducted up to September 2025. Eligible RCTs compared string removal with cystoscopy. The primary outcome was pain assessed by the Visual Analogue Scale (VAS), with subgroup analyses by sex. Secondary outcomes included urinary tract infection (UTI) and other complications. Data synthesis used Review Manager 5.4, with risk of bias and evidence certainty assessed via GRADE. Results: Five RCTs involving 598 patients were included. Compared with cystoscopy, string removal significantly reduced pain (MD –2.49, 95% CI –3.55 to –1.43, p < 0.01), particularly among females (MD –1.66, 95% CI –2.69 to –0.64, p < 0.01), while no significant benefit was found in males (MD –1.05, 95% CI –3.75 to 1.64, p = 0.44). The incidence of UTI did not differ significantly between groups (RR 1.45, 95% CI 0.48–4.42). Sensitivity analysis suggested instability of results, and stent migration could not be quantitatively assessed due to low event rates. Conclusion: Extraction string removal may be associated with lower pain, especially in female patients, without clearly increasing complications. However, the limited number of studies and substantial heterogeneity indicate low certainty of evidence, and further well-designed RCTs are needed to confirm these findings.
Keywords: Lithotripsy, Meta - analysis, systematic review, ureteral stent with string, Visual analogue scale
Received: 05 Oct 2025; Accepted: 22 Jan 2026.
Copyright: © 2026 Dong, Zheng, Jiang and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Weijie Chen
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