- Design
- Systematic review and meta-analysis of retrospective comparative studies
- Population
- 707 patients having robot-assisted upper urinary tract reconstruction
- Primary outcome
- Surgical success
- Effect
- 93.5% vs 86.5%, OR 2.82 (1.57-5.07)
A meta-analysis in the Journal of Robotic Surgery (16 October 2026) pooled five retrospective studies of 707 patients having robot-assisted ureteral reconstruction or pyeloplasty, comparing those who had a period without a stent across the diseased segment (often with nephrostomy drainage) against those operated on directly.
Ureteral rest was associated with higher surgical success (93.5% vs 86.5%; OR 2.82, 95% CI 1.57-5.07) and slightly less blood loss (about 24 mL). Operative time, length of stay and complications did not differ.
The idea is that removing a stent lets oedema and inflammation settle so the true extent of the stricture can be judged. The data are retrospective and definitions varied, so the finding is hypothesis-generating, but it supports considering a planned stent-free interval before elective reconstruction.
- Consider removing the stent and draining by nephrostomy for a period before elective reconstruction
- Reassess stricture length after ureteral rest before choosing the repair
- Discuss the trade-off of a nephrostomy with the patient
- Treat this as hypothesis-generating pending prospective data
Why it matters
A simple step before surgery may improve the odds of a durable repair.
Don't overread it
Five retrospective studies with varied definitions - not yet a standard of care.
The statistics, in plain English
An odds ratio of 2.82 corresponds to an absolute increase in success of about 7.6 percentage points. Retrospective studies cannot exclude that patients chosen for rest differed in other ways.
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