{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T22:56:31Z","timestamp":1791413791066,"version":"4.3.3"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ureteral stent removal using an extraction string after lithotripsy is gaining popularity; however, evidence regarding patient outcomes remains limited. This meta-analysis aimed to evaluate pain and complications associated between string-based and cystoscopic stent removal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search of PubMed, Web of Science, Embase, the Cochrane Library, and Scopus was conducted up to September 2025. Eligible randomized controlled trials (RCTs) compared string-based stent removal with cystoscopic stent removal. The primary outcome was pain, assessed using the Visual Analog Scale (VAS), with subgroup analyses performed by sex. Secondary outcomes included urinary tract infection (UTI) and other complications. Data synthesis was performed using Review Manager 5.4, and risk of bias and certainty of evidence were assessed using the GRADE approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Five RCTs involving 598 patients were included. Compared with cystoscopic stent removal, string-based stent removal significantly reduced pain [mean difference (MD) \u22122.49, 95% confidence interval (CI) \u22123.55 to \u22121.43,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.01], particularly among women (MD \u22121.66, 95% CI \u22122.69 to \u22120.64,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.01), while no significant pain reduction was observed among men (MD \u22121.05, 95% CI \u22123.75 to 1.64,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.44). The incidence of UTI did not differ significantly between groups (risk ratio 1.45, 95% CI 0.48\u20134.42). Sensitivity analyses suggested instability of results, and stent migration could not be quantitatively assessed due to low event rates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Extraction string-based removal may be associated with lower pain, especially among female patients, without a clear increase in complications. However, the limited number of studies and substantial heterogeneity result in a low certainty of evidence, and further well-designed RCTs are needed to confirm these findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251069187<\/jats:ext-link>\n                      , PROSPERO CRD420251069187.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1718954","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T06:40:52Z","timestamp":1771483252000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Effects of ureteral stent removal using an extraction string following ureteroscopic lithotripsy: a systematic review and meta-analysis of randomized controlled trials"],"prefix":"10.3389","volume":"13","author":[{"given":"Ce","family":"Dong","sequence":"first","affiliation":[{"name":"Yuhuan People's Hospital","place":["Taizhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Zheng","sequence":"additional","affiliation":[{"name":"Yuhuan People's Hospital","place":["Taizhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YuCheng","family":"Jiang","sequence":"additional","affiliation":[{"name":"The Second People\u2019s Hospital of Tongxiang","place":["Jiaxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weijie","family":"Chen","sequence":"additional","affiliation":[{"name":"The Second People\u2019s Hospital of Tongxiang","place":["Jiaxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.urology.2018.02.007","article-title":"Evolution of the ureteral stent: the pivotal role of the gibbons ureteral catheter","volume":"115","author":"Donahue","year":"2018","journal-title":"Urology"},{"key":"B2","doi-asserted-by":"publisher","first-page":"80","DOI":"10.4103\/0974-7796.65108","article-title":"A knotted ureteral stent: a case report and review of the literature","volume":"2","author":"Picozzi","year":"2010","journal-title":"Urol Ann"},{"key":"B3","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/0090-4295(86)90080-4","article-title":"Simplified method of indwelling ureteral stent removal","volume":"28","author":"Siegel","year":"1986","journal-title":"Urology"},{"key":"B4","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1111\/bju.12541","article-title":"Do ureteric stent extraction strings affect stent-related quality of life or complications after ureteroscopy for urolithiasis: a prospective randomised control trial","volume":"113","author":"Barnes","year":"2014","journal-title":"BJU Int"},{"key":"B5","doi-asserted-by":"crossref","DOI":"10.1002\/9781119536604","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins","year":"2019"},{"key":"B6","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1213\/ANE.0000000000004014","article-title":"Systematic review and meta-analysis: sometimes bigger is indeed better","volume":"128","author":"Vetter","year":"2019","journal-title":"Anesth Analg"},{"key":"B7","doi-asserted-by":"crossref","DOI":"10.1002\/9781119536604","volume-title":"A Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins","year":"2019"},{"key":"B8","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1186\/s12894-025-01784-w","article-title":"Evaluation of postoperative safety and comfort of ureteral stent removal with extraction string in modified split-leg prone percutaneous nephrolithotomy","volume":"25","author":"Jiang","year":"2025","journal-title":"BMC Urol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"644","DOI":"10.1089\/end.2013.0693","article-title":"Tubeless percutaneous nephrolithotomy using antegrade tether: a randomized study","volume":"28","author":"Agrawal","year":"2014","journal-title":"J Endourol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1111\/bju.14622","article-title":"Impact of ureteric stent removal by string on patient\u2019s quality of life and on complications at post-ureteroscopy for urolithiasis: a controlled trial","volume":"124","author":"Inoue","year":"2019","journal-title":"BJU Int"},{"key":"B11","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1186\/s12894-015-0114-6","article-title":"Rethinking of ureteral stent removal using an extraction string; 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