Lv G. et al., 2022: Safety and efficacy of extracorporeal shock wave lithotripsy vs. flexible ureteroscopy in the treatment of urinary calculi: A systematic review and meta-analysis.
Lv G, Qi W, Gao H, Zhou Y, Zhong M, Wang K, Liu Y, Zhang Q, Zhou C, Li Y, Zhang L, Zhang D.
Department of Urology, Qilu Hospital of Shandong University, Jinan, China.
Department of Urology, The People's Hospital of Xin Tai City, Xintai, China.
Department of Nursing, Qilu Hospital of Shandong University, Jinan, China.
Objective: This study aims to compare the safety and efficacy of extracorporeal shock wave lithotripsy (SWL) and flexible ureteroscopy lithotripsy (f-URS) in treating urinary tract stones.
Methods: We systematically searched PubMed, Embase, and Cochrane for literature comparing SWL with f-URS. The primary outcomes we focused on were stone-free rate (SFR) and complications; the secondary outcomes were operation time, hospital stay, retreatment rate, number of sessions, and auxiliary procedures rate. We used ReviewManager version 5.4.1 and STATA version 14.2 for meta-analysis.
Results: Seventeen studies with a total of 2,265 patients were included in the meta-analysis, including 1,038 patients in the SWL group and 1,227 patients in the f-URS group. The meta-analysis indicated that patients in the f-URS group had higher SFR than those in the SWL group [odds ratio (OR): 2.00, 95% confidence interval (CI): 1.29-3.12, p = 0.002]. In addition, we found no significant difference in complications (OR: 1.08, 95% CI: 0.85-1.37) between the two treatments. Also, we found that the retreatment rate and the auxiliary procedure rate in the f-URS group were significantly lower than those in the SWL group (OR: 0.08, 95% CI: 0.02-0.24, p < 0.00001; OR: 0.30, 95% CI: 0.11-0.83, p = 0.02). Moreover, the number of sessions in the f-URS group was significantly lower than that in the SWL group [mean difference (MD): -1.96, 95% CI: -1.55 to -0.33, p = 0.003]. However, the operation time and hospital stay in the f-URS group were significantly longer than those in the SWL group (MD: 11.24, 95% CI: 3.51-18.56, p = 0.004; MD: 1.14, 95% CI: 0.85-1.42, p < 0.00001).
Conclusion: For 1-2-cm urinary stones, f-URS can achieve a higher SFR than SWL while having a lower retreatment rate, number of sessions, and auxiliary procedure rate. For urinary stones <1 cm, there was no significant difference in SFR between SWL and f-URS groups. The SWL group has a shorter operative time and hospital stay than the f-URS group.
Front Surg. 2022 Nov 7;9:925481. doi: 10.3389/fsurg.2022.925481. eCollection 2022. PMID: 36420414. FREE ARTICLE. Review.
There is apparently an almost unlimited need to compare endoscopic stone removal with SWL, despite numerous publications on this issue. In the current report a systematic review and meta-analysis is presented to compare fURS and SWL. The study is based on 8 RCTs and 9 cohort analyses comprising in total 2265 patients: 1227 treated with fURS and 1038 with SWL. The problem with this and all (and they are many) other similar studies is that an endoscopic procedure requiring anesthesia, in-hospital care and access to an operating theatre is compared with SWL carried out without anesthesia (only analgesics) in an out-patient setting and without need of resources provided by the operating department. Accordingly, the authors finish their report by emphasizing aspects on quality of life.
It is difficult to ignore the fact that operators aware of a comparative study either take special care in the procedure or are selected because of their specific skill and expertise. Having said that it is important to state that the differences between the two treatment modalities to some extent was predictable. One point that needs to be added is the uncertainty of the level of ambition in SWL.
Briefly the overall outcome of the review can be summarized as follows:
With this report I hope that there is enough systematic reviews carried out between fURS and SWL until there is any substantial improvement either in SWL-technology or how it is carried out or any important progress in follow-up procedures that can change the differences between the two treatment modalities.