Wang YB et al, 2018: Efficacies of Various Surgical Regimens in the Treatment of Renal Calculi Patients: a Network Meta-Analysis in 25 Enrolled Controlled Clinical Trials.
Wang YB, Cui YX, Song JN, Yang Q, Wang G.
Department of Urology, Third Operating Room, First Operating Room, Second Operating Room, the First Hospital of Jilin University, Changchun, China.
BACKGROUND/AIMS: Renal calculi, or kidney stones, are masses made of crystals that affect people of all geographical, cultural, and racial groups. We conduct this study with the aim of comparing the efficacy of various surgical methods in the treatment of renal calculi.
METHODS: Controlled clinical trials (CCTs) related to different surgical treatment approaches for renal calculi were included in this study by retrieving them from electronic English databases. The odds ratios (OR), the weighted mean difference (WMD), 95% confidence intervals (95% CI) and surface under the cumulative ranking curves (SUCRA) were evaluated, followed by a cluster analysis.
RESULTS: Compared with the extracorporeal shockwave lithotripsy (SWL), minimally invasive percutaneous nephrolithotomy (mini-PCNL), retrograde intrarenal surgery (RIRS), standard percutaneous nephrolithotomy (standard PCNL), ureterorenoscopy (URS) and micro-percutaneous nephrolithotomy (microperc) regimens, the open anatrophic nephrolithotomy (Open AN), URS + RIRS and laparoscopic pyelolithotomy (LP) surgical procedures all presented with a higher stone-free rate in renal calculi. Lower auxiliary procedures were found in the URS + RIRS treatment approach compared with SWL, RIRS, URS and microperc regimens. In addition, the SWL regimen indicated a lower stone-free rate than the mini-PCNL, standard PCNL, Open AN, URS + RIRS and LP regimens. Finally, the RIRS regimen presented with the shortest in-patient stay compared to the mini-PCNL, standard PCNL, Open AN, URS, URS + RIRS and LP regimens.
CONCLUSION: This meta-analysis demonstrated that the URS + RIRS surgical procedure has the best stone-free rate and the lowest number of auxiliary procedures. The RIRS and Microperc both have the shortest hospital stay and operative time.
Kidney Blood Press Res. 2018 Jul 31;43(4):1183-1198. doi: 10.1159/000492246. [Epub ahead of print]
Another Network Meta-Analysis.
A simple rule to avoid wasting time is: do not read meta-analyses which do not state in the introduction what metaanalyses have been previously published on the subject and what the new message of the present analysis is.
The present manuscript does not even quote previous studies in the discussion.
My impression is that the authors may be good statisticians but have very limited knowledge of the urological subject they are dealing with. Otherwise it is difficult to understand some conclusions: “Our study also demonstrated that SWL had a higher complication rate than mini-PCNL, RIRS, standard PCNL, URS and microperc. Previous studies have found that renal injury may exist after SWL [61, 62]. Moreover, complications after an unsuccessful SWL procedure occurred at nearly five times the frequency .” Even the quoted literature seems to have been misunderstood: 63. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3852342/