Deng T et al, 2018: Systematic review and cumulative analysis of the managements for proximal impacted ureteral stones.
Deng T, Chen Y, Liu B, Laguna MP, de la Rosette JJMCH, Duan X, Wu W, Zeng G.
Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1#, Haizhu District, Guangzhou, 510230, China.
Guangzhou Institute of Urology, Guangzhou, China.
Guangdong Key Laboratory of Urology, Guangzhou, China.
Department of Urology, Longgang District Central Hospital, Shenzhen, China.
Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China.
Department of Urology, Istanbul Medipol University, Istanbul, Turkey.
AMC University Hospital, Amsterdam, The Netherlands.
PURPOSE: To compare the efficacy and safety of different treatment options for the management of proximal impacted ureteral stones (PIUS).
METHODS: A systematic literature search using Pubmed, Medline, Embase and Cochrane Library was conducted to obtain studies concerning different managements for PIUS up to Jan 2018. Summary odds ratios (ORs), standard mean differences (SMDs) or weighted mean differences with their 95% confidence intervals (CIs) were calculated to compare the efficacy and safety of all included treatment methods, registered in PROSPERO under number CRD42018092745.
RESULTS: A total of 15 comparative studies with 1780 patients were included. Meta-analyses of final stone-free rate (SFR) favored percutaneous nephrolithotomy (PCNL) over ureteroscopic lithotripsy (URL) (OR 10.35; 95% CI 5.26-20.35; P < 0.00001), laparoscopic ureterolithotomy over URL (OR 0.11; 95% CI 0.05-0.25; P < 0.00001) and URL over extracorporeal shockwave lithotripsy (OR 0.47; 95% CI 0.28-0.77; P = 0.003). As to complications, PCNL had a significantly higher blood transfusion rate (OR 7.47; 95% CI 1.3-42.85; P = 0.02) and a lower ureteral injury rate (OR 0.15; 95% CI 0.04-0.52; P = 0.003) compared with URL. It also shared a significantly lower stone-retropulsion rate (OR 0.03; 95% CI 0.01-0.15; P < 0.0001) and higher treatment costs (SMD = 2.71; 95% CI 0.71-4.70; P = 0.008) than URL.
CONCLUSIONS: Our meta-analysis suggested that PCNL might be the best option for PIUS owing to its higher successful rate. Complications such as hemorrhage could be decreased by the application on mini-PCNL.
World J Urol. 2018 Nov 14. doi: 10.1007/s00345-018-2561-7. [Epub ahead of print]
In this review, based on few comparative and randomized studies on treatment of impacted proximal ureteral stones, the results of SWL were inferior to those obtained with PNL, URS and LU (laparoscopic ureterolithotomy).
It is possible that following a long period of obstruction caused by the stone; pre-SWL stenting might have been of value both for the kidney and for improving the results. That is an approach (with internal stent or ureteral catheter) that I personally have applied successfully in many patients with impacted ureteral stones.