Primary Versus Delayed Ureteroscopy for Obstructing Ureteric Calculi: A Systematic Review and Meta-analysis from the European Association of Urology Endourology.
6 affiliations
- 1Strategic Academic Recruitment Programme, Royal College of Surgeons in Ireland, Dublin, Ireland.
- 2Department of Urology and Transplant Surgery, Beaumont Hospital, Dublin, Ireland.
- 3Department of Urology, Blackrock Clinic, Dublin, Ireland.
- 4Department of Urology, National and Kapodistrian University of Athens, Athens, Greece.
- 5Department of Urology, Sismanogleio Hospital, Athens, Greece.
- 6Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Abstract
Background and objective
Primary ureteroscopy (URS; P-URS) for obstructing ureteric stones involves emergent stone retrieval within 24-48 h of acute presentation. We compared the effectiveness of P-URS versus delayed URS (D-URS) for noninfected obstructing ureteric stones.Methods
A systematic review was conducted using PubMed, Embase, Cochrane Library, and Scopus from database inception up to October 2025. Studies comparing P-URS with D-URS were eligible. Primary outcomes were stone-free rate (SFR) and complications. Secondary outcomes included retreatment, sepsis, stent use, readmissions, and costs. Random-effects meta-analysis and meta-regression were performed for prespecified study-level moderators.Key findings and limitations
Fifteen studies involving 19 907 patients were included. Pooled SFR in P-URS was 89% (confidence interval [CI] = 80-95) and D-URS 87% (CI = 77-94). There was no statistically significant difference in SFR between P-URS and D-URS in an all-studies meta-analysis (odds ratio [OR] 1.20; 95% CI = 0.75-1.92; p = 0.5) with substantial heterogeneity (I² = 86%). In a subgroup of five studies using a zero-fragmentation definition on any postoperative imaging modality (radiographic zero fragment rate [ZFR]), P-URS was associated with higher odds of stone-free status (OR 1.49, 95% CI = 1.10-2.02, I² = 0%). Sensitivity analysis restricted to two computed tomography (CT)-based trials (strict ZFR) showed a larger effect (OR 1.95, 95% CI = 1.19-3.19, I² = 0%). Complications and secondary outcomes did not differ materially between approaches. Limitations include methodological heterogeneity, predominantly retrospective designs, and sparse data using strict ZFR definitions.Conclusions and clinical implications
P-URS appears to be a feasible option for selected patients with noninfected obstructing ureteric stones without large overall differences in SFR or complication rates compared with D-URS. In radiographic and strict CT-based ZFR subgroups, P-URS shows modestly higher SFRs, but these signals arise from few studies and should be considered hypothesis generating. Future research should incorporate contemporary technology, patient-reported outcomes, and formal cost-effectiveness analyses.
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BibTeX
@article{sugrue2026primary,
title = {{Primary Versus Delayed Ureteroscopy for Obstructing Ureteric Calculi: A Systematic Review and Meta-analysis from the European Association of Urology Endourology.}},
author = {Diarmuid D Sugrue and Orla Cullivan and Fintan R Ryan and Andreas Skolarikos and Bhaskar Somani and Niall F Davis},
journal = {European urology open science},
year = {2026},
month = oct,
doi = {10.1016/j.euros.2026.09.007},
url = {https://europepmc.org/article/MED/42898237},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Primary Versus Delayed Ureteroscopy for Obstructing Ureteric Calculi: A Systematic Review and Meta-analysis from the European Association of Urology Endourology.
AU - Diarmuid D Sugrue
AU - Orla Cullivan
AU - Fintan R Ryan
AU - Andreas Skolarikos
AU - Bhaskar Somani
AU - Niall F Davis
PY - 2026
DA - 2026/10/09
JO - European urology open science
DO - 10.1016/j.euros.2026.09.007
UR - https://europepmc.org/article/MED/42898237
AB - Background and objective Primary ureteroscopy (URS; P-URS) for obstructing ureteric stones involves emergent stone retrieval within 24-48 h of acute presentation. We compared the effectiveness of P-URS versus delayed URS (D-URS) for noninfected obstructing ureteric stones.Methods A systematic review was conducted using PubMed, Embase, Cochrane Library, and Scopus from database inception up to October 2025. Studies comparing P-URS with D-URS were eligible. Primary outcomes were stone-free rate (SFR) and complications. Secondary outcomes included retreatment, sepsis, stent use, readmissions, and costs. Random-effects meta-analysis and meta-regression were performed for prespecified study-level moderators.Key findings and limitations Fifteen studies involving 19 907 patients were included. Pooled SFR in P-URS was 89% (confidence interval [CI] = 80-95) and D-URS 87% (CI = 77-94). There was no statistically significant difference in SFR between P-URS and D-URS in an all-studies meta-analysis (odds ratio [OR] 1.20; 95% CI = 0.75-1.92; p = 0.5) with substantial heterogeneity (I² = 86%). In a subgroup of five studies using a zero-fragmentation definition on any postoperative imaging modality (radiographic zero fragment rate [ZFR]), P-URS was associated with higher odds of stone-free status (OR 1.49, 95% CI = 1.10-2.02, I² = 0%). Sensitivity analysis restricted to two computed tomography (CT)-based trials (strict ZFR) showed a larger effect (OR 1.95, 95% CI = 1.19-3.19, I² = 0%). Complications and secondary outcomes did not differ materially between approaches. Limitations include methodological heterogeneity, predominantly retrospective designs, and sparse data using strict ZFR definitions.Conclusions and clinical implications P-URS appears to be a feasible option for selected patients with noninfected obstructing ureteric stones without large overall differences in SFR or complication rates compared with D-URS. In radiographic and strict CT-based ZFR subgroups, P-URS shows modestly higher SFRs, but these signals arise from few studies and should be considered hypothesis generating. Future research should incorporate contemporary technology, patient-reported outcomes, and formal cost-effectiveness analyses.
SN - 2666-1691
SN - 2666-1683
ER -