Wang W. et al., 2021: Does previous unsuccessful shockwave lithotripsy influence the outcomes of ureteroscopy?-a systematic review and meta-analysis.
Wang W, Peng L, Di X, Gao X, Wei X.
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Background: To determine whether previous unsuccessful shockwave lithotripsy (SWL) influence the outcomes of ureteroscopy (URS).
Methods: An exhaustive search of PubMed, EMBASE, Web of Science and Cochrane Library were conducted to find eligible studies before October 2020. Result variables consisting stone-free rate (SFR), operation time and postoperative modified Clavien grade I-IV complications were pooled utilizing RevMan 5.3.
Results: Seven studies with 2413 individuals were included. Pooled results revealed that the salvage URS after failed SWL was similar to URS performed primarily regarding SFR [odds ratio (OR) =0.84, P=0.15] and operation time [weighted mean difference (WMD) =6.79, P=0.19]. Additionally, no statistically significant differences concerning fever (OR: 1.36; P=0.32), hematuria (OR: 0.81; P=0.75), urinary tract infection (OR: 1.57; P=0.28), renal colic (OR: 1.94; P=0.50), ureteral perforation (OR: 1.44; P=0.46), ureteral avulsion (OR: 1.21; P=0.83), stone migration (OR: 0.92; P=0.86) and sepsis (OR: 0.46; P=0.38) were observed between salvage URS and primary URS group.
Discussion: The success rates and complications of URS were not impacted by previous unsuccessful SWL. The salvage URS is equally effective and safe to primary URS.
Transl Androl Urol. 2021 May;10(5):2122-2132. doi: 10.21037/tau-21-39. PMID: 34159093. FREE ARTICLE
One aspect of concern over the years has been whether failed or only partially successful SWL has a negative influence on subsequent endourological procedures? In this regard the current article is reassuring.
The authors aimed to answer the question in a systematic review and meta-analysis. In this review the question asked was if results of URS were negatively affected in patients who previously had been subject to unsuccessful SWL.
Pooled results from seven studies comprising 2413 patients showed that the result of URS was not negatively affected by a previous treatment with SWL.
There is no reason to refrain from SWL by fear of making alternative treatments less successful if it is not possible to solve the problem with SWL.