Predictors of success and failure in outpatient ureteral stenting under local anaesthesia: a systematic review and proposed clinical guide from EAU Endourology.

Authors

Muhannad Aljoulani, Arianna Pischetola, Jia-Lun Kwok, Ali Talyshinskii, Steffi Yuen, Vineet Gauhar, Daniele Castellani, Federico Zorzi, Stefano Moretto, Giovanni Liguori, Michele Rizzo, Bhaskar K Somani, Amelia Pietropaolo

Published in

World journal of urology. Volume 44. Issue 1. Jul 29, 2026. Epub Jul 29, 2026.

Abstract

Outpatient retrograde ureteral stenting under local anesthesia (LA) is increasingly adopted to reduce anesthetic risk, resource use, and procedural delays. However, success rates and tolerance vary across benign and malignant obstruction. This systematic review evaluated technical success, safety, pain and tolerance, and clinical predictors of failure to inform patient selection and procedural planning.
Following PRISMA 2020 statement, MEDLINE, Embase, Scopus, and Web of Science were searched from inception to October 2025. Twenty studies involving adults undergoing ureteral stent insertion or exchange under LA in outpatient, office-based, or bedside settings were included. Data were synthesized using random-effects meta-analysis with logit transformation. Predictors of success and failure were assessed qualitatively and quantitatively where feasible.
Across 1,945 patients (2,871 ureteral units), pooled technical success was 89% (95% CI 86-92%), highest for stone-related obstruction (94%) and lowest for malignant ureteral obstruction (82%). Overall complications ranged from 2 to 14%, with major events (Clavien-Dindo ≥ II) occurring in < 5%. Pain scores were modest (VAS 3.1-4.6), and 87-90% of patients were willing to undergo repeat LA stenting. Independent predictors of technical failure included bladder trigone or distal ureteric invasion, severe hydronephrosis, and poor performance status (ECOG ≥ 2). Limitations include heterogeneity in outcome definitions, lack of multivariable modelling in most studies, and short-term follow-up.
LA ureteral stenting is safe, effective, and well tolerated in carefully selected patients. Predictors of failure offer a practical framework to guide decision-making between outpatient LA stenting, operating-room stenting, and percutaneous drainage. Standardized reporting and prospective validation of risk models are needed.

PMID:
42525236
Bibliographic data and abstract were imported from PubMed on 29 Jul 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.