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Metallic ureteric stents show a trend toward lower failure rates than polymeric stents in malignant obstructionMetallic stents may lower failure rates in certain kidney conditions

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Key Takeaway
Note that metallic stents show a trend toward lower failure rates than polymeric stents in malignant ureteric obstruction.

This meta-analysis evaluated the comparative efficacy of metallic versus polymeric ureteric stents in 511 patients with chronic malignant ureteric obstruction. The analysis included data from 595 stents to evaluate primary outcomes such as stent failure and secondary outcomes including symptoms, complications, and functional duration.

The study found a trend toward lower stent failure rates with metallic stents compared to polymeric stents (RR 0.68; 95% CI 0.44-1.03; p = 0.07). While the reduction in failure was not statistically significant, a narrative synthesis indicated fewer exchange requirements for metallic stents. Other outcomes, including stent-related symptoms and Clavien-Dindo complications, were reported as comparable between both stent types.

The authors noted several limitations, including the use of retrospective designs, clinical heterogeneity, and sparse data regarding patient-centered outcomes and cost-effectiveness. Specifically, renal outcomes, quality of life, and cost implications could not be pooled due to inconsistent reporting across studies.

Clinically, metallic ureteric stents may serve as a feasible long-term alternative for selected patients with chronic malignant ureteric obstruction. However, the current evidence is not practice-changing, and the association between stent type and reduced failure remains statistically non-significant.

Living with a blockage in the ureter—the tube that carries urine from the kidney to the bladder—can be a constant challenge for people with certain types of cancer. Doctors often use stents, which are small tubes placed inside the body, to keep these pathways open. This study looked at whether metallic stents offer any advantages over the standard plastic (polymeric) ones.

The researchers looked at 511 patients and nearly 600 stents. They found that metallic stents showed a trend toward lower failure rates compared to plastic ones. While this difference was not statistically significant, the data suggested that metallic options might need fewer replacements over time. However, both types of stents resulted in similar levels of patient symptoms and complications.

Because much of the original data came from older reports and varied significantly between clinics, we cannot say for certain that one is better than any other yet. The evidence is not enough to change standard medical practice today, but it highlights metallic stents as a possible long-term option for some patients.

What this means for you:
Metallic stents may last longer and need fewer replacements than plastic ones in specific cancer cases.

Common questions

Are metallic stents better than plastic ones?

The study found a trend toward lower failure rates with metallic stents compared to polymeric (plastic) ones. However, this result was not statistically significant. Both types of stents resulted in similar levels of patient symptoms and complications.

Do metallic stents cause more side effects?

No, the study found that stent-related symptoms and other common complications were comparable between metallic and polymeric stents. Both options appear to be tolerated similarly by patients in this group.

How often do metallic stents need to be replaced?

The data suggests there are fewer requirements to exchange the stent when using a metallic option compared to a plastic one. This could mean fewer procedures for some patients over time.

Study Details

Study typeMeta analysis
Sample sizen = 511
EvidenceLevel 1
PublishedAug 2026
View Original Abstract ↓
BACKGROUND: Chronic malignant ureteric obstruction compromises renal function and may disrupt oncological management. Conventional polymeric stents are limited by external compression, encrustation, and frequent exchange requirements. Metallic stents were developed to enhance long-term patency; however, comparative evidence remains heterogeneous. METHODS: A PRISMA-compliant systematic review of PubMed, MEDLINE, Embase, Web of Science, Cochrane CENTRAL, and Scopus (31 May 2025) identified comparative studies of metallic versus polymeric ureteric stents in adults with chronic malignant ureteric obstruction. Random-effects meta-analysis evaluated stent failure, stent-related symptoms, and Clavien-Dindo complications using risk ratios. Functional duration, renal outcomes, quality of life, and cost implications were synthesised narratively. RESULTS: Six retrospective cohort studies encompassing 511 patients and 595 ureteric stents met inclusion criteria. Metallic stents showed a trend toward lower stent failure compared with polymeric stents (RR 0.68, 95% CI 0.44-1.03; I² = 0%, p = 0.07). Stent-related symptoms and complication rates were comparable. Metallic stents demonstrated fewer exchange requirements in narrative synthesis, although renal function, quality-of-life, and cost outcomes could not be pooled because of inconsistent reporting. CONCLUSIONS: Metallic ureteric stents are a feasible long-term alternative to polymeric stents for selected patients with chronic malignant ureteric obstruction, with potential benefits in reducing exchange burden. Current evidence is not practice-changing and remains limited by retrospective designs, clinical heterogeneity, and sparse patient-centred and cost-effectiveness data. TRIAL REGISTRY: Prospero: CRD420251021868.
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