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Sokouti M. et al., 2023: A systematic review and meta-analysis on the outcomes of extracorporeal shock wave compared to ureteroscopic lithotripsy for the treatment of ureteral stones.

Sokouti M, Sokouti M, Sokouti B.
Health Promotion Research Center, Tabriz Medical Sciences, Islamic Azad University, Tabriz, Iran.
Department of Physiology, Faculty of Medicine, Tabriz Medical Sciences, Islamic Azad University, Tabriz, Iran.
Department of Cardiothoracic Surgery, Tabriz University of Medical Sciences, Tabriz, Iran.
Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Abstract

Objectives: In this systematic review and meta-analysis, we sought to identify whether extracorporeal shockwave lithotripsy (ESWL) or ureteroscopic lithotripsy (URSL) is the most appropriate method for treating ureteral stones.

Methods: We identified relevant literature by searching the Google Scholar and PubMed databases in accordance with PRISMA guidelines. We focused on the outcomes of extracorporeal shockwave lithotripsy and ureteroscopic lithotripsy. For each method, we compared complications, hematuria, perforation, failure, stone clearance, initial stone-free, operating time, stone size, auxiliary procedures, and overall stone-free outcomes. Our analysis involved meta-analysis, heterogeneity testing, subgroup analysis, meta-regression sensitivity analyses, Egger's tests, Smoothed Variance Egger's (SVE) testing, and Smoothed Variance Thomson (SVT) testing. In addition, we detected publication bias for all outcomes related to the two procedures.

Results: Based on ten eligible studies, we conducted a meta-analysis on a total of 1509 patients. Extracorporeal shockwave lithotripsy was used to treat 677 patients; the remaining 832 patients were treated by the ureteroscopic lithotripsy procedure. Considering the meta-analysis statistical parameters including odds ratio (OR), standardized mean difference (SMD), Q, I2 and their p-values, the overall stone-free, operating time, stone size outcomes were identified with significant OR, SMD, and Q values. The hematuria, failure, and stone clearance outcomes were determined to have significant Q values. The perforation and initial stone free outcomes had significant OR values. And, complications and auxiliary urinary procedures were not significant in terms of OR and Q values.

Conclusions: Analysis indicated that ESWL and URSL procedures are essential for the treatment of ureteral stones, even though the perforation rate is higher for URSL than for ESWL. Overall stone-free rates were better for the URSL procedure.

J Taibah Univ Med Sci. 2023 Jun 14;18(6):1459-1471. doi: 10.1016/j.jtumed.2023.06.001. eCollection 2023 Dec.PMID: 37441243
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Comments 1

Hans-Göran Tiselius on Friday, 09 February 2024 10:00

This article emphasizes the current trend in urolithiasis research that it is much more attractive to summarize what others have done than to produce own research results. The authors accordingly carried out a systematic review and meta-analysis, according to the PRISMA method, in which 10 reports were included (from Pakistan, Nepal, Japan and Egypt). Of these reports three were RCTs. It is disappointing that the Abstract contains so little hard data.

The article comprises a very long and extensive summary of statistical data obtained from the PRISMA system. Unfortunately, the way of presentation makes reading difficult and the Figures (2,3 and 4) are too small to enable clear interpretation of the message.

One of the conclusions was that the stone-free rate was significantly better following URS than with SWL. This conclusion is expected, but it is less easy to understand why stone clearance did not differ between the two methods. The statement on page 1468, that “ureteral perforation” were better for URS must be an error in text writing?

Although systematic reviews sometimes add valuable information to our knowledge, the value of comparing heterogeneous subgroups is doubtful. It is the reviewer’s opinion that authors’ own research data obtained with a high level of ambition and with full control of the methodology is superior to stereotypic systematic reviews.

Hans-Göran Tiselius

This article emphasizes the current trend in urolithiasis research that it is much more attractive to summarize what others have done than to produce own research results. The authors accordingly carried out a systematic review and meta-analysis, according to the PRISMA method, in which 10 reports were included (from Pakistan, Nepal, Japan and Egypt). Of these reports three were RCTs. It is disappointing that the Abstract contains so little hard data. The article comprises a very long and extensive summary of statistical data obtained from the PRISMA system. Unfortunately, the way of presentation makes reading difficult and the Figures (2,3 and 4) are too small to enable clear interpretation of the message. One of the conclusions was that the stone-free rate was significantly better following URS than with SWL. This conclusion is expected, but it is less easy to understand why stone clearance did not differ between the two methods. The statement on page 1468, that “ureteral perforation” were better for URS must be an error in text writing? Although systematic reviews sometimes add valuable information to our knowledge, the value of comparing heterogeneous subgroups is doubtful. It is the reviewer’s opinion that authors’ own research data obtained with a high level of ambition and with full control of the methodology is superior to stereotypic systematic reviews. Hans-Göran Tiselius
Monday, 20 May 2024