Supplementary Material for: Prestenting Versus Nonprestenting on the Outcomes of Flexible Ureteroscopy for Large Upper Urinary Stones: A Systematic Review and Meta-Analysis

Introduction: The purpose of this article is to evaluate the efficacy and safety of prestenting (PS) versus non-PS (NPS) of flexible ureteroscopy (fURS) to treat large upper urinary stones. Methods: We conducted a systematic literature research of PubMed, Ovid, Scopus (up to August 2019), and citation lists to identify eligible studies. All studies comparing PS versus NPS of fURS were included. Data were analyzed using the Cochrane Collaboration’s Review Manager (RevMan) 5.3 software. Results: Overall, 7 studies including 3,145 patients (PS 1,408; NPS 1,737) were included in this article. PS group was associated with older age (weighted mean difference [WMD] 0.91 year; p < 0.001) and more male patients (odds ratio [OR] 1.34; p < 0.001). There were no statistical differences between PS and NPS in BMI (WMD 0.34 kg/m2; p = 0.13), stone size (WMD 0.13 mm; p = 0.77), and operative time (WMD 0.44 min; p = 0.86). Compared with NPS, PS showed better initial success rate (OR 4.04; p < 0.001) and higher SFR (OR 1.64; p < 0.001). There were no statistical differences for complications (OR 0.84; p = 0.42) and Clavien-Dindo score ≥3 complications (OR 1.04; p = 0.93). Conclusion: PS could improve initial success rate and avoid secondary general anesthesia for first ureteral access sheath failed patients. PS could provide better SFR than NPS in the treatment of large upper urinary stones with fURS.

引言：本文旨在评估柔性输尿管镜（flexible ureteroscopy, fURS）术中术前留置输尿管支架（prestenting, PS）与不留置输尿管支架（non-PS, NPS）治疗大体积上尿路结石的有效性与安全性。
方法：我们对PubMed、Ovid、Scopus（检索截止至2019年8月）及相关文献的参考文献列表开展系统文献检索，以筛选符合纳入标准的研究。所有对比柔性输尿管镜术中PS与NPS方案的研究均被纳入本研究。数据采用考克兰协作网的Review Manager（RevMan）5.3软件进行统计分析。
结果：本研究共纳入7项研究，合计3145例患者（PS组1408例，NPS组1737例）。PS组患者年龄更大（加权均数差[weighted mean difference, WMD]=0.91年；p<0.001），男性占比更高（比值比[odds ratio, OR]=1.34；p<0.001）。两组在体重指数（Body Mass Index, BMI）、结石大小（加权均数差=0.13mm；p=0.77）及手术时长（加权均数差=0.44min；p=0.86）方面均无统计学差异。与NPS组相比，PS组初始手术成功率更高（比值比=4.04；p<0.001），结石无残留率（stone-free rate, SFR）更优（比值比=1.64；p<0.001）。两组在并发症发生率（比值比=0.84；p=0.42）及克拉维埃-丁多分级（Clavien-Dindo score）≥3级的并发症发生率（比值比=1.04；p=0.93）方面均无统计学差异。
结论：对于首次尝试输尿管通路鞘置入失败的患者，术前留置输尿管支架可提升初始手术成功率，避免再次接受全身麻醉。在采用柔性输尿管镜治疗大体积上尿路结石时，PS方案的结石无残留率优于NPS方案。