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Sharma G. et al., 2021: Comparison of efficacy and safety of various management options for large upper ureteric stones a systematic review and network meta-analysis.

Sharma G, Pareek T, Tyagi S, Kaundal P, Yadav AK, Thummala Y, Devana SK.
Department of Urology, Advanced Urology Center, Postgraduate Institute of Medical Education and Research (PGIMER), Level II, B Block, Sector 12, Chandigarh, 160012, India.
Department of Urology, Advanced Urology Center, Postgraduate Institute of Medical Education and Research (PGIMER), Level II, B Block, Sector 12, Chandigarh, 160012, India.

Abstract

To compare the safety and efficacy of various surgical modalities to manage large (> 1 cm) upper ureter stones. Systematic literature search was conducted to include all randomized studies comparing various treatment options for large (> 1 cm) upper ureteric stones. This review included 13 randomized studies with 1871 patients. Laparoscopic ureterolithotomy (LUL) and percutaneous nephrolithotomy (PNL) were superior to ureteroscopy (URS) and shockwave lithotripsy (SWL) for stone-free rates and need for auxiliary treatments. LUL and PNL were equally effective for stone-free rates and the need for auxiliary treatments. According to SUCRA values for stone-free rates and the need for auxiliary treatments, LUL was the best, followed by PNL. For the duration of surgery, there was no significant difference among all the techniques on network analyses, and SWL was the best according to SUCRA values. Length of hospital stay was significantly shorter for URS than LUL and PNL from network analysis, but there was no significant difference for the rest of the comparisons. Overall complications were similar in all the groups. According to the CINeMa approach, the confidence rating ranged from “very low” to “moderate” for various comparisons. LUL followed by PNL is the most efficacious treatment modality for upper ureteric stones compared to SWL and URS in terms of stone-free rates. However, due to the poor quality of included studies, further high-quality randomized studies are needed.
Sci Rep. 2021 Jun 3;11(1):11811. doi: 10.1038/s41598-021-91364-3. PMID: 34083725. FREE ARTICLE

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Comments 1

Hans-Göran Tiselius on Tuesday, 30 November 2021 09:30

This article is one of the increasingly common “systematic reviews and meta-analysis”. Like several other reports of this kind different methods for stone removal are compared based on published data in the literature collected from articles considered to be of high quality. Unfortunately, the conclusion in this report was that the studies were of poor quality and that further studies are required. In that way the research can continue indefinitely. It is difficult, however, to see that further studies would result in a markedly different outcome.

The specific features of this review is that only ureteral stone > 1 cm were included and that also laparoscopic surgery (LUL) was included as a useful method.

https://www.storzmedical.com/images/blog/Sharma.JPG

The initial SFR following SWL is lower than expected and so is also the result of the initial LUL It is also likely that with repeated SWL with or without auxiliary procedures the final result of SWL should be better than 72%. The reason for the outcome of SWL is that this method can be used at various levels of ambition and sometimes with less experienced operators. This means that the result will vary considerably from one centre to another.

Hans-Göran Tiselius

This article is one of the increasingly common “systematic reviews and meta-analysis”. Like several other reports of this kind different methods for stone removal are compared based on published data in the literature collected from articles considered to be of high quality. Unfortunately, the conclusion in this report was that the studies were of poor quality and that further studies are required. In that way the research can continue indefinitely. It is difficult, however, to see that further studies would result in a markedly different outcome. The specific features of this review is that only ureteral stone > 1 cm were included and that also laparoscopic surgery (LUL) was included as a useful method. [img]https://www.storzmedical.com/images/blog/Sharma.JPG[/img] The initial SFR following SWL is lower than expected and so is also the result of the initial LUL It is also likely that with repeated SWL with or without auxiliary procedures the final result of SWL should be better than 72%. The reason for the outcome of SWL is that this method can be used at various levels of ambition and sometimes with less experienced operators. This means that the result will vary considerably from one centre to another. Hans-Göran Tiselius
Saturday, 18 May 2024