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

چکیده اصلی

BACKGROUND AND OBJECTIVE: 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. METHODS: 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. KEY FINDINGS AND LIMITATIONS: 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. CONCLUSIONS AND CLINICAL IMPLICATIONS: 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.

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