Externalized Ureteral Catheter Versus Double-J Stent in Tubeless Percutaneous Nephrolithotomy for Upper Urinary Stones: A Systematic Review and Meta-Analysis

Objective: The objective of this meta-analysis was to compare the efficacy and safety of externalized ureteral catheter (EUC) and Double-J stent (DJS) in tubeless percutaneous nephrolithotomy (PCNL) for patients with upper urinary stones based on published literature. Materials and Methods: A comprehensive literature search using Pubmed, Embase, and Cochrane Library was performed to find studies comparing outcomes of EUC and DJS for treating patients with upper urinary stones up to December 2017. Seven studies, which included 863 patients from 5 randomized controlled trials (RCTs) and 2 non-RCTs published between 2009 and 2017, met our inclusion criteria and were included in this systematic review and meta-analysis. Between-studies heterogeneity was assessed and sensitivity analysis was conducted based on RCTs. Results: The stent-related symptoms were higher for DJS compared with EUC (odds ratio [OR]: 0.09; confidence interval [95% CI]: 0.01-0.61; p=0.01). No significant differences were found in minor (Clavien I-II) complications (OR: 1.37; 95% CI: 0.93-2.01; p=0.11), major (Clavien III-V) complications (OR: 1.38; 95% CI: 0.73-2.60; p=0.32), hemoglobin drop (weighted mean difference [WMD]: -1.43g/L; 95% CI: -3.65 to 0.78; p=0.2), pain score (VAS) (WMD: 0.01; 95% CI: -0.28 to 0.29; p=0.95), analgesic required (OR: 1.02; 95% CI: 0.77-1.34; p=0.91), stone-free rate (risk ratio: 0.98; 95% CI: 0.9-1.07; p=0.67), duration of hospitalization (WMD: -0.21 days; 95% CI: -0.86 to 0.44; p=0.53), and operative times (WMD: -7.59 minutes; 95% CI: -18.81 to 3.64; p=0.19). Conclusion: We concluded that compared with DJS, EUC is also an effective alternative for patients with upper urinary stones in tubeless PCNL and could help patients by reducing stent-related discomfort and avoiding cystoscopy for DJS removal. However, the inherent limitations of the included studies should be considered, and well-designed RCTs with further large sample size should be performed to validate our findings.