Comparison of pigtail suture stent vs conventional DJ stent in ureteral stent symptom occurrences: A systematic review and meta-analysis.

Abstract

<h4>Introduction</h4>Pigtail suture stent (PSS) was introduced to reduce the occurrence of ureteral stent symptoms that often occur after placement of DJ stent for most endourology procedures. This study aims to conduct a review and meta-analysis to compare the occurrence of ureteral stent symptoms between PSS and conventional DJ stent using the validated Ureteral Stent Symptom Questionnaire (USSQ).<h4>Methods</h4>Literature search was done under the PRISMA guidelines. Eligible studies were included, data were extracted, and pooled analyses were made according to each domain of the Ureteral Stent Symptom Questionnaire (USSQ), namely Urinary Index score, Pain Index score, General Health Index score, Work Performance Score, and Sexual Matters. Pooled effect estimates were generated as Mean difference and their 95%CI, statistical significance was defined with P-value < 0.05, and heterogeneity was examined using I² analyses. Sensitivity analyses were done to omit confounding.<h4>Results</h4>A total of four eligible studies were identified and included in the meta-analysis. A total of 314 patients were included across two RCTs and two prospective cohort studies. Among the USSQ domain, Urinary index (MD = -10.11; 95% CI: -15.24, -4.98; <i>p</i> = 0.0001), pain index control (MD = -8.05; 95% CI: -15.63, -0.48; <i>p</i> = 0.04), and work performance (MD = -1.90; 95% CI: -2.34, -1.46; <i>p</i> < 0.00001) were found to be improved better in PSS compared to conventional DJ stent, while general health index and sexual matter were comparable. Sensitivity analyses were conducted, and no studies were omitted.<h4>Conclusion</h4>Ureteral stent-related symptoms were significantly better in the PSS compared to conventional DJ stent post-endoscopic surgeries in urology, in terms of urinary and pain index, as well as the work performance domain of USSQ. Limitations include the small number of studies, heterogeneity in study design, and differences in PSS type used.