We conducted a Pooled analysis to investigate the efficacy and safety of ureteral stent removal using an extraction string.Methods:A systematic review was performed by using the Preferred Reporting Items for Systematic Reviews and Pooled analyses. The sources including EMBASE, MEDLINE, and the Cochrane Controlled Trials Register were retrieved to gather randomized controlled trials of ureteral stent removal using an extraction string. The reference of included literature was also searched.Results:Four randomized controlled trials containing a amount of 471 patients were involved in the analysis. We found that the ureteral stent removal using an extraction string group had a greater decrease of visual analog scale (VAS) (Mean difference (MD) -1.40, 95% confidence interval (CI) -1.99 to -0.81, P<.00001) compared with the no string group. The string group did not show a significant differences in Ureteric Stent Symptom Questionnaire (USSQ) (P=.15), general health (P=.77), stent dwell time (P=.06), and urinary tract infection (UTI) (P=.59) with exception of stent dislodgement (Odds Ratio (OR) 10.36, 95% CI 2.40 to 44.77, P=.002) compared with the no string group.Conclusions:Ureteral stent removal by string significantly provides less pain than those by cystoscope for patients without increasing stent-related urinary symptoms or UTI. However, this must be balanced against a risk of stent dislodgement and, hence, may not be a good option in all patients. © 2019 the Author(s). Published by Wolters Kluwer Health, Inc.