Image not available

Drake T et al, 2017: What are the Benefits and Harms of Ureteroscopy Compared with Shock-wave Lithotripsy in the Treatment of Upper Ureteral Stones? A Systematic Review.

Drake T, Grivas N, Dabestani S, Knoll T, Lam T, Maclennan S, Petrik A, Skolarikos A, Straub M, Tuerk C, Yuan CY, Sarica K.
Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK.
Department of Urology, Hatzikosta General Hospital, Ioannina, Greece; Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Department of Urology, Skåne University Hospital, Malmö, Sweden.
Department of Urology, Sindelfingen-Boeblingen Medical Center, University of Tübingen, Sindelfingen, Germany.
Department of Urology, Aberdeen Royal Infirmary, Aberdeen, Scotland; Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland.
Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland.
Department of Urology, Charles University, First Faculty of Medicine, Prague, Czech Republic; Department of Urology, Hospital Ceske Budejovice, Czech Republic.
Second Department of Urology, Sismanoglio Hospital, Athens Medical School, Athens, Greece.
Department of Urology, Technical University Munich, Munich, Germany.
Department of Urology, Hospital of the Sisters of Charity, Vienna, Austria.
Division of Gastroenterology & Cochrane UGPD Group, Department of Medicine, Health Sciences Centre, McMaster University, Hamilton, Canada.
Department of Urology, Dr. Lutfi Kirdar Research and Teaching Hospital, Istanbul, Turkey.

Abstract

CONTEXT: Extracorporeal shock wave lithotripsy (SWL) and ureteroscopy (URS), with or without intracorporeal lithotripsy, are the most common treatments for upper ureteric stones. With advances in technology, it is unclear which treatment is most effective and/or safest.
OBJECTIVE: To systematically review literature reporting benefits and harms of SWL and URS in the management of upper ureteric stones.
EVIDENCE ACQUISITION: Databases including Medline, Embase, and the Cochrane library were searched from January 2000 to November 2014. All randomised controlled trials (RCTs), quasi-randomised controlled trials, and nonrandomised studies comparing any subtype or variation of URS and SWL were included. The primary benefit outcome was stone-free rate (SFR). The primary harm outcome was complications. Secondary outcomes included retreatment rate, need for secondary, and/or adjunctive procedures. The Cochrane risk of bias tool was used to assess RCTs, and an extended version was used to assess nonrandomised studies. Grading of Recommendations Assessment, Development, and Evaluation was used to assess the quality of evidence.
EVIDENCE SYNTHESIS: Five thousand-three hundred and eighty abstracts and 387 full-text articles were screened. Forty-seven studies met inclusion criteria; 19 (39.6%) were RCTs. No studies on children met inclusion criteria. URS and SWL were compared in 22 studies (4 RCTs, 1 quasi-randomised controlled trial, and 17 nonrandomised studies). Meta-analyses were inappropriate due to data heterogeneity. SFR favoured URS in 9/22 studies. Retreatment rates were higher for SWL compared with URS in all studies but one. Longer hospital stay and adjunctive procedures (most commonly the insertion of a JJ stent) were more common when primary treatment was URS. Complications were reported in 11 out of 22 studies. In eight studies, it was possible to report this as a Clavien-Dindo Grade. Higher complication rates across all grades were reported for URS compared with SWL. For intragroup (intra-SWL and intra-URS) comparative studies, 25 met the inclusion criteria. These studies varied greatly in outcomes measured with data being heterogeneous.
CONCLUSIONS: Compared with SWL, URS was associated with a significantly greater SFR up to 4 wk but the difference was not significant at 3 mo in the included studies. URS was associated with fewer retreatments and need for secondary procedures, but with a higher need for adjunctive procedures, greater complication rates, and longer hospital stay.

Eur Urol. 2017 Apr 26. pii: S0302-2838(17)30324-X. doi: 10.1016/j.eururo.2017.04.016. [Epub ahead of print] Review.

 

0
 

Comments 1

Peter Alken on Friday, 17 November 2017 08:50

This systematic review is perfectly done and highly recommended for reading not only the results but also the way the publications were scrutinized.
When reading such literature reviews, it is frequently a surprise to see how few solid papers were published within a long time period - here 14 years between 2000 and 2014. Only a few studies - here 47 of initially 5380 searched and 387 scrutinized for eligibility - were of value to be included in such an analysis. Somehow these numbers seem to suggest that reading most day-to-day publications - some 340 of 387 and probably many more of 5380 - is of no value and the majority of publications probably add more to confuse than to inform the reader. Even the quality of the included 47 publications was very variable with e.g. 6 not giving the time point when SFR was determined.

Nevertheless the last sentence is a solid statement: “We found that both treatments are safe and effective options that should be offered based on individual patient circumstances and preferences”.

This systematic review is perfectly done and highly recommended for reading not only the results but also the way the publications were scrutinized. When reading such literature reviews, it is frequently a surprise to see how few solid papers were published within a long time period - here 14 years between 2000 and 2014. Only a few studies - here 47 of initially 5380 searched and 387 scrutinized for eligibility - were of value to be included in such an analysis. Somehow these numbers seem to suggest that reading most day-to-day publications - some 340 of 387 and probably many more of 5380 - is of no value and the majority of publications probably add more to confuse than to inform the reader. Even the quality of the included 47 publications was very variable with e.g. 6 not giving the time point when SFR was determined. Nevertheless the last sentence is a solid statement: “We found that both treatments are safe and effective options that should be offered based on individual patient circumstances and preferences”.
Guest
Saturday, 15 December 2018
STORZ MEDICAL AG
Lohstampfestrasse 8
8274 Tägerwilen
Switzerland
Tel.: +41 (0)71 677 45 45
Fax: +41 (0)71 677 45 05

www.storzmedical.com