Mi Y et al, 2015: Flexible ureterorenoscopy (F-URS) with holmium laser versus extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stone
Mi Y, Ren K, Pan H, Zhu L, Wu S, You X, Shao H, Dai F, Peng T, Qin F, Wang J, Huang Y.
Department of Urology, Third Affiliated Hospital of Nantong University, Wuxi, Jiangsu, China.
Department of Orthopedics, The Affiliated Jiangyin Hospital of Southeast University Medical School, Wuxi, Jiangsu, China.
The objective of the study was to systematically review the efficacy and safety of flexible ureterorenoscopy (F-URS) with holmium laser versus extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal stone <2 cm. A systematic literature review was performed in April 2015 using the PubMed, Embase, Web of Science and the Chinese Biomedical Literature (CNKI and Wanfang) databases to identify relevant studies. All clinical trials were retrieved and their included references investigated. Two reviewers independently assessed the quality of all included studies, and the eligible studies were included and analyzed using the RevMan 5.3 software. Six prospective randomized comparison trials and eight retrospective comparison trials were included, involving a total of 2348 patients. For renal stone 1-2 cm, F-URS technique provided a significantly higher stone-free rate (SFR) [weighted mean difference (WMD) = 2.35, 95 % confidence interval (CI) 1.65-3.34, P < 0.00001], lower auxiliary procedure rate (APR) [odds ratio (OR) 0.33, 95 % CI 0.22-0.50, P < 0.00001] and lower retreatment rate (RR) (OR 0.07, 95 % CI 0.01-0.37, P = 0.002). Similar results were found in the lower pole stone for 1-2 cm subgroup. For renal stone <1 cm, F-URS technique also showed a significantly higher SFR than ESWL (WMD = 2.13, 95 % CI 1.13-4.00, P = 0.02). F-URS is associated with higher SFR, lower APR and RR than ESWL. F-URS is a safe and effective procedure. It can successfully treat patients with stones for 1-2 cm, especially for lower pole stone, without increasing complications, operative time and hospital stay. F-URS can be used as an alternative treatment to ESWL in selected cases with larger renal stones. However, further randomized trials are needed to confirm these findings.
Urolithiasis. 2015 Nov 4. [Epub ahead of print]
A similar meta-analysis on the same subject was recently published and reviewed (Zheng C, Yang H, Luo J, Xiong B, Wang H, Jiang Q. Extracorporeal shock wave lithotripsy versus retrograde intrarenal surgery for treatment for renal stones 1-2 cm: a meta-analysis. Urolithiasis. November 2015, Volume 43, Issue 6, 549-556) and the trend towards a reduced ESWL application is confirmed in both publications.
Unfortunately my comment to the previous publication also exactly applies to the present one:
>The abstracts’ last sentence “However, further randomized trials are needed to confirm these findings” is frequently found at the end of original papers on this topic. It is somehow disappointing to find it also at the end of a meta-analysis.