Li H. et al., 2022: Does prior failed shock-wave lithotripsy impact outcomes of ureterorenoscopy? A systematic review and meta-analysis.
Li H, Hu XF, Deng L, Zhang L, Li H.
Urology Department, Clinical Laboratory, Chengdu Fifth People's Hospital, Sichuan, China.
Objective: The study aimed to compare the outcomes of patients undergoing ureterorenoscopy (URS) after failed shock-wave lithotripsy (SWL) (Salvage URS) with those undergoing URS without any history of SWL (Primary URS).
Materials and methods: PubMed, Embase, and CENTRAL databases were searched up to 10th January 2021 for studies comparing outcomes of salvage URS vs. primary URS. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for procedure success and complications. Operating time was summarized using mean difference (MD).
Results: Seven retrospective studies were included. Meta-analysis indicated no statistically significant difference in the success rates of URS between the salvage URS and primary URS groups (OR: 0.83 95% CI: 0.65, 1.06 I2=0% p=0.13). On subgroup analysis, the success rate was significantly reduced in the salvage URS group for renal stones (OR: 0.55 95% CI: 0.34, 0.91 I2=0% p=0.02) but with no difference for ureter stones OR: 0.90 95% CI: 0.67, 1.21 I2=0% p=0.49). Pooled analysis demonstrated a tendency of longer operating time in the salvage URS group as compared to the primary URS group, albeit with a statistically non-significant difference (MD: 8.91 95% CI: -0.56, 18.38 I2=98% p=0.07). Meta-analysis indicated significantly increased complications in the salvage URS group as compared to the primary URS group (OR: 1.83 95% CI: 1.34, 2.49 I2=0% p=0.0001).
Conclusions: Evidence from retrospective studies suggests that patients undergoing salvage URS for renal stones have significantly lower success rates which is not the case for ureteral stones. There is a non-significant tendency of increased operating times for salvage URS. Complication rates are significantly higher for salvage URS as compared to primary URS. Future studies with propensity-score matching are required to strengthen current conclusions.
Eur Rev Med Pharmacol Sci. 2022 Apr;26(7):2501-2510. doi: 10.26355/eurrev_202204_28486. PMID: 35442465. FREE ARTICLE
For removal of stones and ureters, guidelines give two options, either primary URS/RIRS or primary SWL. In view of the common need of repeated treatment following one session of SWL, the question that can be raised is if primary SWL negatively affects the outcome of URS/RIRS as a secondary (salvage) procedure?
To shed light on that issue the authors carried out a systematic review and meta-analysis based on data reported in seven retrospective studies. A comparison in this regard was made between primary URS/RIRS and primary SWL.
Interestingly there were no significant overall differences in success rates between the two strategies. The success rate, however, was lower for renal than for ureteral stones. (p=0.02). The most relevant finding was that complications were more common following salvage URS. In all studies URS/RIRS was chosen as the secondary procedure and it had indeed been interesting to compare salvage URS/RIRS with repeated SWL.
One factor discussed is the effect of embedded fragments. How commonly that occurred is not known, but if such an effect is of importance a lower success would have been expected for ureteral stones. That was, however, not the case!
There were obvious variation and heterogeneity between the studies, but these factors were considered of minor importance.
The authors emphasize that surgeons’ experience was an important factor for both operating time and complications with URS. Not mentioned is that experience also is an important pre-requisite for successful primary SWL.