Difference between magnetic versus conventional ureteral stents in morbidity and efficiency after double J stents removal: A systematic review and meta-analysis of randomized controlled trials.

Abstract

Context: Ureteral stents are crucial in urological surgery, promoting urine passage and preventing obstruction. They have undergone design, material, and covering changes to minimize pain and enhance efficiency. Researchers are exploring the use of magnetic stents, which use magnets attached to the stent's end.

Aims: This research aims to evaluate and analyze the expulsion of magnetic double J (DJ) stents as compared to conventional methods DJ stents, using qualitative and quantitative data from the literature about morbidity, discomfort, cost, duration, safety, and efficiency.

Settings and design: This research is a systematic review and meta-analysis of randomized controlled trials (RCTs).

Subjects and methods: RCTs comparing the removal of magnetic DJ stents to conventional stents were identified through an extensive search Scopus, Web of Science, PubMed, and Cochrane from January 2014 to January 2024. The search methodology and criteria for eligibility were developed using a modified PICO framework, and the risk of bias in the RCTs was evaluated with the RoB-2 tool. The removal duration, ureteral stent symptom questionnaire (USSQ), and pain (measured by visual analog scale) were pooled for meta-analysis.

Statistical analysis used: The Cochrane Collaboration tool called Review Manager 5.4 will be used to collect quantitative data. The main outcome was evaluated using continuous data, with the mean difference (MD) and a 95% confidence interval (CI) applied. A P < 0.05 was deemed statistically significant. Heterogeneity between studies will be evaluated in this meta-analysis using I² (I²; Inconsistency).

Results: There were six RCT studies involving 570 participants that were finally eligible for the quantitative analysis. Magnetic DJ stent was found to significantly shorten the duration of removal (MD -30.51; 95% CI, -51.82--9.21; P = 0.005) and less pain during removal (MD -2.71; 95% CI, -3.74--1.68; P < 0.00001) than conventional DJ stent. USSQ scores for urinary symptoms (MD 1.88; 95% CI, 0.56-3.19; P = 0.005) and sexual matters (MD 1.18; 95% CI, 0.54-1.82; P = 0.0003) were significantly higher for magnetic than for conventional stents.

Conclusions: Magnetic DJ stent removal offers enhanced safety, efficiency, less pain, a shorter time of removal, and lower costs compared to conventional methods. However, it has a higher UUSQ score for urinary symptoms and sexual matters.