Ramadhan M. et al., 2025: Ultrasound versus fluoroscopy-guided extracorporeal shockwave lithotripsy in renal calculi: a systematic review and meta-analysis.
Mohammed Ramadhan 1, Arthur Braga 2, Mohammad Alzaid 3, Tarek Benzouak 4, Fadl Hamouche 5 6, Ahmad Almarzouq 7 8
1Department of Surgery, Jaber Al-Ahmad Hospital, South Surra, Kuwait.
2Bahiana School of Medicine and Public Health, State of Bahia, Salvador, Brazil.
3School of Medical Sciences, University of Manchester, Manchester, UK.
4Faculty of Medicine, McGill University, Montreal, QC, Canada.
5Department of Surgery, Division of Urology, University of Calgary, Calgary, Canada.
6Southern Alberta Institute of Urology, Calgary, Alberta, T2V 1P9, Canada.
7Department of Surgery, Jaber Al-Ahmad Hospital, South Surra, Kuwait.
8Department of Surgery, Sabah Al-Ahmad Urology Center, Shuwaikh Medical Area, Kuwait City,
Abstract
Extracorporeal shockwave lithotripsy (ESWL) is one of the first-line treatments in the management of renal stones and is usually performed using fluoroscopic (FS) guidance. Ultrasonography (US) is a potential alternative with minimal radiation exposure. The primary aim of this study was to compare the stone free rate (SFR) between US and FS guided ESWL. The secondary outcomes were overall complications, re-intervention rate, hematuria, UTI, pain occurrence and number of shocks required. A prospectively registered systematic review and meta-analysis (CRD42024511335) according to PRISMA guidelines, was conducted. MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, were searched up to February 15, 2024. Snowballing techniques and Google Scholar were used for external gray literature. Adult and pediatric subgroups were pooled and individually analyzed. Twelve studies were identified with 2673 patients. Ultrasonography yielded a significantly favorable SFR (OR 1.43;95%CI [1.06-1.94]; P = 0.02). This difference was found only in the adult subgroup. No differences were found between modalities, nor within any subgroup in terms of secondary outcomes. In this meta-analysis, US-ESWL demonstrated a higher SFR compared to standard FS-ESWL However, this finding was shown only in adult patients, and although there was no difference in pediatric patients, the minimized radiation exposure remains an attractive attribute in US-ESWL.These results should be interpreted cautiously, due to a limited number of RCTs and heterogeneity between studies. More research is needed especially in pediatric populations, to further elucidate the role of US in ESWL.
Urolithiasis. 2025 Feb 26;53(1):41. doi: 10.1007/s00240-025-01696-2. PMID: 40009135
Comments 1
There currently is becoming popular to use ultrasound in SWL. This is a new trend. The major reason for maintaining fluoroscopy is that it is much easier to use. But the advantage of reducing radiation is beyond discussion. The articles referred to in this report obviously were based on studies in which the operators were well educated to use ultrasound.
Some essential data of the 12 studies in the report are summarized below.
The results are very good. The reason for getting good results in pediatric patients might be that it is much easier to hold the stone in focus in anesthetized patients. Further conclusions are not possible because of the small number of RCTs as well as the relative small number of patients.
Hans-Göran Tiselius