Sani A. et al., 2025: Urolithiasis management: An umbrella review on the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) versus the ureteroscopic approach.

Thursday, 07 August 2025

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Anis Sani 1, Rasa Beheshti 1, Rozhin Khalichi 1, Maryam Taraghikhah 1, Elaheh Nourollahi 1, Ashkan Shafigh 2, Fariba Pashazadeh 2, Morteza Ghojazadeh 2, Hadi Mostafaei 2 3, Hanieh Salehi-Pourmehr 2, Sakineh Hajebrahimi 2
1Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
2Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
3Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.

Abstract

This Umbrella Review aims to gather high-quality evidence on urolithiasis outcomes and complications, comparing extracorporeal shockwave lithotripsy (ESWL), ureteroscopic lithotripsy (URSL), and retrograde intrarenal surgery (RIRS). We incorporated systematic reviews, some containing meta-analyses, into two separate reports, focusing on quantitative and qualitative results. Additionally, when data permitted, a secondary meta-analysis was conducted using final effect estimates from multiple meta-analyses. Stone-free rate (SFR) served as the primary outcome, with complications, retreatment, and hospital stay as secondary outcomes. Adhering to Joanna Briggs Institute (JBI) guidelines, we initially screened 282 titles, narrowed down to 166 titles and abstracts, ultimately selecting 55 full-text articles for review. Of these, 22 met our inclusion criteria for the umbrella review. We evaluated study quality using JBI criteria, excluding five low-quality studies. Analysis showed ESWL had lower SFR compared to RIRS (RR: 0.577, 95% CI: 0.482-0.692) and URSL (RR: 0.570, 95% CI: 0.450-0.722); lower overall risk compared to ureteroscopy (RR: 0.58, 95% CI: 0.51-0.66). ESWL had fewer complications than RIRS (p < 0.001), but lower SFR than ureteroscopy. However, the need for retreatment and auxiliary procedures in RIRS and URSL were lower than that in ESWL. In contrast, individuals undergoing ureteroscopy experienced a greater frequency of complications and longer duration of operation compared to those undergoing ESWL.

Urologia. 2025 May;92(2):294-311. doi: 10.1177/03915603241313162. Epub 2025 Jan 22.
PMID: 39840617

Comments 1

Peter Alken on Thursday, 07 August 2025 11:00

If you are an averagely informed reader, you do not need to read the abstract, the article or the commentary.

This publication has ambitious goals:
” Despite the numerous published systematic reviews in this area, there have yet to be a common conclusion of comparison between these methods. Given the differences in methodology, quality, and reporting across the assessments, as well as their frequent conflicting conclusions, it is essential to provide a clear overview of this evidence. The objective of this Umbrella Review is to gather the highest quality evidence regarding the effectiveness and complications of ESWL, RIRS, and URSL in treating urolithiasis.”

These are the techniques used:
“The study utilized a systematic approach, evaluating 282 initial titles, resulting in 22 qualifying studies for the umbrella review after rigorous screening and elimination of duplicates.”
“Methods”
“This study conducts an umbrella review, which rigorously examines multiple systematic evaluations concerning health outcomes associated with a particular exposure, whether or not they include meta-analysis.13 The methods outlined by the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement were adhered to in
conducting this umbrella review.” …
“Data extraction was conducted utilizing the JBI Data Extraction Form for Systematic Reviews and Research Syntheses. The extraction list encompassed various elements such as name of author, publication year, objective, participant characteristics, study count and sample size, sources and scope of search, study design, assessment tools, critical evaluation criteria, I2statistic for gauging publication bias, analytical approach, results/findings, and the extent of heterogeneity.”
“The JBI critical evaluation instrument was utilized to evaluate the systematic reviews’ methodology as well as the techniques they employed to address and minimize bias. … Studies with ⩽5 “yes”
responses in an assessment were excluded.”
“13. Aromataris E, Fernandez R, Godfrey CM, et al. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc 2015; 13: 132–140”

The results:
This indirect “second” analysis of data generated since the databases were established until shortly before the publication date, covering 27,911 patients and published in 22 publications between 2011 and 2021, shows the following key findings:
“The most commonly studied outcomes were SFR, complication rate, retreatment, auxiliary procedures, hospital stay, and operation time.”

Results confirm what is known about ESWL, URS and RIRS.
The ambitious goals could not be met as the limitations were “Heterogeneity was a significant limitation of this methodological approach. This arose from the absence of a standardized definition of outcome measures and the inconsistent reporting of the definitions used.”

The conclusion
The conclusion consequently, suggests a well-known solution:” It is advised to conduct comprehensive randomized controlled trials to thoroughly assess the outcomes of both interventions in different stone sizes and locations.”

There is no new information and no new message, neither concerning the results nor the fact that the quality of publications is generally low.
Why was this paper written and published?
We will see more papers like this, not written by 11 authors but by AI which is a repetition machine.

Peter Alken

If you are an averagely informed reader, you do not need to read the abstract, the article or the commentary.

This publication has ambitious goals: 
” Despite the numerous published systematic reviews in this area, there have yet to be a common conclusion of comparison between these methods. Given the differences in methodology, quality, and reporting across the assessments, as well as their frequent conflicting conclusions, it is essential to provide a clear overview of this evidence. The objective of this Umbrella Review is to gather the highest quality evidence regarding the effectiveness and complications of ESWL, RIRS, and URSL in treating urolithiasis.”

These are the techniques used:
 “The study utilized a systematic approach, evaluating 282 initial titles, resulting in 22 qualifying studies for the umbrella review after rigorous screening and elimination of duplicates.” 
“Methods”
“This study conducts an umbrella review, which rigorously examines multiple systematic evaluations concerning health outcomes associated with a particular exposure, whether or not they include meta-analysis.13 The methods outlined by the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement were adhered to in
conducting this umbrella review.” …
“Data extraction was conducted utilizing the JBI Data Extraction Form for Systematic Reviews and Research Syntheses. The extraction list encompassed various elements such as name of author, publication year, objective, participant characteristics, study count and sample size, sources and scope of search, study design, assessment tools, critical evaluation criteria, I2statistic for gauging publication bias, analytical approach, results/findings, and the extent of heterogeneity.”
“The JBI critical evaluation instrument was utilized to evaluate the systematic reviews’ methodology as well as the techniques they employed to address and minimize bias. … Studies with ⩽5 “yes”
responses in an assessment were excluded.”
“13. Aromataris E, Fernandez R, Godfrey CM, et al. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc 2015; 13: 132–140”

The results:
This indirect “second” analysis of data generated since the databases were established until shortly before the publication date, covering 27,911 patients and published in 22 publications between 2011 and 2021, shows the following key findings:
“The most commonly studied outcomes were SFR, complication rate, retreatment, auxiliary procedures, hospital stay, and operation time.”

Results confirm what is known about ESWL, URS and RIRS.
The ambitious goals could not be met as the limitations were “Heterogeneity was a significant limitation of this methodological approach. This arose from the absence of a standardized definition of outcome measures and the inconsistent reporting of the definitions used.”

The conclusion
The conclusion consequently, suggests a well-known solution:” It is advised to conduct comprehensive randomized controlled trials to thoroughly assess the outcomes of both interventions in different stone sizes and locations.”

There is no new information and no new message, neither concerning the results nor the fact that the quality of publications is generally low.
Why was this paper written and published?
We will see more papers like this, not written by 11 authors but by AI which is a repetition machine.

Peter Alken

If you are an averagely informed reader, you do not need to read the abstract, the article or the commentary. This publication has ambitious goals: ” Despite the numerous published systematic reviews in this area, there have yet to be a common conclusion of comparison between these methods. Given the differences in methodology, quality, and reporting across the assessments, as well as their frequent conflicting conclusions, it is essential to provide a clear overview of this evidence. The objective of this Umbrella Review is to gather the highest quality evidence regarding the effectiveness and complications of ESWL, RIRS, and URSL in treating urolithiasis.” These are the techniques used: “The study utilized a systematic approach, evaluating 282 initial titles, resulting in 22 qualifying studies for the umbrella review after rigorous screening and elimination of duplicates.” “Methods” “This study conducts an umbrella review, which rigorously examines multiple systematic evaluations concerning health outcomes associated with a particular exposure, whether or not they include meta-analysis.13 The methods outlined by the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement were adhered to in conducting this umbrella review.” … “Data extraction was conducted utilizing the JBI Data Extraction Form for Systematic Reviews and Research Syntheses. The extraction list encompassed various elements such as name of author, publication year, objective, participant characteristics, study count and sample size, sources and scope of search, study design, assessment tools, critical evaluation criteria, I2statistic for gauging publication bias, analytical approach, results/findings, and the extent of heterogeneity.” “The JBI critical evaluation instrument was utilized to evaluate the systematic reviews’ methodology as well as the techniques they employed to address and minimize bias. … Studies with ⩽5 “yes” responses in an assessment were excluded.” “13. Aromataris E, Fernandez R, Godfrey CM, et al. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc 2015; 13: 132–140” The results: This indirect “second” analysis of data generated since the databases were established until shortly before the publication date, covering 27,911 patients and published in 22 publications between 2011 and 2021, shows the following key findings: “The most commonly studied outcomes were SFR, complication rate, retreatment, auxiliary procedures, hospital stay, and operation time.” Results confirm what is known about ESWL, URS and RIRS. The ambitious goals could not be met as the limitations were “Heterogeneity was a significant limitation of this methodological approach. This arose from the absence of a standardized definition of outcome measures and the inconsistent reporting of the definitions used.” The conclusion The conclusion consequently, suggests a well-known solution:” It is advised to conduct comprehensive randomized controlled trials to thoroughly assess the outcomes of both interventions in different stone sizes and locations.” There is no new information and no new message, neither concerning the results nor the fact that the quality of publications is generally low. Why was this paper written and published? We will see more papers like this, not written by 11 authors but by AI which is a repetition machine. Peter Alken

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