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Pre-stenting and medical therapies, such as alpha-blockers, may improve outcomes by facilitating ureteral access sheath placements and reducing complications. This systematic review and meta-analysis aimed to evaluate the effects of pre-stenting and preoperative pharmacological agents on ureteroscopy outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review and meta-analysis following PRISMA guidelines. A comprehensive literature search was performed across multiple databases, identifying randomized controlled trials comparing ureteroscopy outcomes with and without pre-stenting and pre-ureteroscopy medical therapy. Primary outcomes included failure rates in accessing the upper urinary tract, while secondary outcomes encompassed operative times, complications, and stone-free rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The analysis included 16 randomized controlled trials, revealing that pre-stenting and medical therapy significantly reduced failure rates (Relative Ratio 0.44, 95% CI 0.33\u20130.59, p &lt; 0.001) and operative times (Mean Difference \u221210.81 min, 95% CI \u221213.45 to \u22128.18, p &lt; 0.001). Additionally, there was a higher stone-free rates, lower need for postoperative stenting and fewer complications associated with preoperative ureteral dilation interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Preoperative alpha blockers enhance ureteroscopy success and reduces complications. The evidence supports their use before ureteroscopy for renal and ureteral stones, improving patient outcomes and procedural efficiency. Patients pre-stented for any reason demonstrated significantly improved ureteroscopic access and stone-free rates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00345-025-05848-2","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T16:10:21Z","timestamp":1755015021000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["The influence of pre-stenting and drugs on the outcomes of ureteroscopy for kidney and ureteral stone disease: a systematic review and meta-analysis by the EAU Section of Endourology"],"prefix":"10.1007","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9956-1558","authenticated-orcid":false,"given":"Steffi Kar Kei","family":"Yuen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7354-9190","authenticated-orcid":false,"given":"Daniele","family":"Castellani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0928-0507","authenticated-orcid":false,"given":"Theodoros","family":"Tokas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4209-8670","authenticated-orcid":false,"given":"Giacomo Maria","family":"Pirola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9934-4011","authenticated-orcid":false,"given":"Carlo","family":"Giulioni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9758-6225","authenticated-orcid":false,"given":"Jia-Lun","family":"Kwok","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6150-3988","authenticated-orcid":false,"given":"Mohamed Amine","family":"Lakmichi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7410-0712","authenticated-orcid":false,"given":"Takafumi","family":"Yanagisawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7631-3108","authenticated-orcid":false,"given":"Amelia","family":"Pietropaolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4493-1301","authenticated-orcid":false,"given":"Thomas","family":"Herrmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6248-6478","authenticated-orcid":false,"given":"Bhaskar","family":"Somani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3740-7141","authenticated-orcid":false,"given":"Vineet","family":"Gauhar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,12]]},"reference":[{"issue":"1","key":"5848_CR1","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/j.euf.2022.06.014","volume":"9","author":"RM Geraghty","year":"2023","unstructured":"Geraghty RM, Davis NF, Tzelves L et al (2023) Best practice in interventional management of urolithiasis: an update from the European Association of Urology guidelines panel for urolithiasis 2022. 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