Donaldson JF. et al., 2019: Treatment of Bladder Stones in Adults and Children: A Systematic Review and Meta-analysis on Behalf of the European Association of Urology Urolithiasis Guideline Panel
Donaldson JF, Ruhayel Y, Skolarikos A, MacLennan S, Yuan Y, Shepherd R, Thomas K, Seitz C, Petrik A, Türk C, Neisius A.
Department of Urology, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK.
Department of Urology, Skåne University Hospital, Malmö, Sweden.
Second Department of Urology, Sismanoglio Hospital, Athens Medical School, Athens, Greece.
Academic Urology Unit, University of Aberdeen, Scotland, UK.
Division of Gastroenterology & Cochrane UGPD Group, Department of Medicine, Health Sciences Centre, McMaster University, Hamilton, Canada.
European Association of Urology Guidelines Office, Arnhem, The Netherlands.
Department of Urology, Guy's Hospital, London, UK.
Department of Urology, Medical University of Vienna, General Hospital of Vienna, Vienna, Austria.
Department of Urology, Charles University, First Faculty of Medicine, Prague, Czech Republic.
Department of Urology, Hospital of the Sisters of Charity, Vienna, Austria; Urologische Praxis mit Steinzentrum, Vienna, Austria.
Department of Urology, Hospital of the Brothers of Mercy Trier, Johannes Gutenberg University Mainz, Trier, Germany.
CONTEXT: Bladder stones (BS) constitute 5% of urinary stones. Currently, there is no systematic review of their treatment.OBJECTIVE: To assess the efficacy (primary outcome: stone-free rate [SFR]) and morbidity of BS treatments.EVIDENCE ACQUISITION: This systematic review was conducted in accordance with the European Association of Urology Guidelines Office. Database searches (1970-2019) were screened, abstracted, and assessed for risk of bias for comparative randomised controlled trials (RCTs) and nonrandomised studies (NRSs) with ≥10 patients per group. Quality of evidence (QoE) was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool.EVIDENCE SYNTHESIS: A total of 2742 abstracts and 59 full-text articles were assessed, and 25 studies (2340 patients) were included. In adults, one RCT found a lower SFR following shock wave lithotripsy (SWL) than transurethral cystolithotripsy (TUCL; risk ratio 0.88, p=0.03; low QoE). Four RCTs compared TUCL versus percutaneous cystolithotripsy (PCCL): meta-analyses demonstrated no difference in SFR, but hospital stay (mean difference [MD] 0.82d, p<0.00001) and procedure duration (MD 9.83min, p<0.00001) favoured TUCL (moderate QoE). Four NRSs comparing open cystolithotomy (CL) versus TUCL or PCCL found no difference in SFR; hospital stay and procedure duration favoured endoscopic surgery (very low QoE). Four RCTs compared TUCL using a nephroscope versus a cystoscope: meta-analyses demonstrated no difference in SFR; procedure duration favoured the use of a nephroscope (MD 22.74min, p<0.00001; moderate QoE). In children, one NRS showed a lower SFR following SWL than TUCL or CL. Two NRSs comparing CL versus TUCL/PCCL found similar SFRs; catheterisation time and hospital stay favoured endoscopic treatments. One RCT comparing laser versus pneumatic TUCL found no difference in SFR. One large NRS comparing CL techniques found a shorter hospital stay after tubeless CL in selected cases; QoE was very low.CONCLUSIONS: Current available evidence indicates that TUCL is the intervention of choice for BSs in adults and children, where feasible. Further high-quality research on the topic is required.PATIENT SUMMARY: We examined the literature to determine the most effective and least harmful procedures for bladder stones in adults and children. The results suggest that endoscopic surgery is equally effective as open surgery. It is unclear whether stone size affects outcomes. Shock wave lithotripsy appears to be less effective. Endoscopic treatments appear to have shorter catheterisation time and convalescence compared with open surgery in adults and children. Transurethral surgery, where feasible, appears to have a shorter hospital stay than percutaneous surgery. Further research is required to clarify the efficacy of minimally invasive treatments for larger stones and in young children.
Eur Urol. 2019 Sep;76(3):352-367. doi: 10.1016/j.eururo.2019.06.018. Epub 2019 Jul 13.
I do not agree with the first sentence of this review: “Despite constituting only approximately 5% of all urinary tract stones, bladder stones (BSs) are responsible for 14% of hospital admissions and 8% of urolithiasis-related deaths in developed nations.” The authors get the 8% from a publication in the BJUI with the title “Do stones still kill? An analysis of death from stone disease 1999-2013 in England and Wales”. Mortality data in that publication could not distinguish between bladder stones listed as concomitant diseases on the death certificate or bladder stones being the primary cause of death.
Otherwise this is a long overdue review. “This study provides the first ever systematic review and meta-analyses on the treatment of BSs, and has informed the first national or international guideline on Bladder Stones.“ ESWL is of minor importance in the treatment of bladder stones and the authors concluded: “Our results indicate that SWL was less effective than endoscopic or open surgery in both adults and children in terms of SFR, although the QoE was low or very low. An RCT on small (t al. Do stones still kill? An analysis of death from stone disease 1999-2013 in England and Wales BJU International 2016; 118: 140–144 Free full text