Xu Y et al, 2014: A meta-analysis of the efficacy of ureteroscopic lithotripsy and extracorporeal shock wave lithotripsy on ureteral calculi.
Xu Y, Lu Y, Li J, Luo S, Liu Y, Jia Z, Chen P, Guo Y, Zhao Q, Ma X, Jia S
Department of Urology, Hospital of People's Liberation Army, Chengdu, China.
Nursing Department, Hospital of People's Liberation Army, Chengdu, China.
Hospital of People's Liberation Army, Chengdu, China.
Abstract
PURPOSE: To re-evaluated the clinic efficacy of ureteroscopic lithotripsy (URS) and extracorporeal shock wave lithotripsy (ESWL) on ureteral calculi with Cochrane systematic reviews in this paper. METHODS: We searched clinical randomized controlled trials and prospective controlled trials in databases such as Cochrane library, Medline, Springer, Elsevier Science Direct, PubMed. Pooled estimate of risk ratios (RRs), standard mean difference (SMD) with 95% confidence intervals (CIs) were used as measure of effect sizes. Summary effect estimates were also stratified
by sample size, study design and study region. The overall effect sizes were derived using a random-effects model or fixed-effects model when appreciated, and meta-analysis were conducted with software RewMan 5.0.RESULTS: The meta-analysis suggested that there were significant differences of post-treatment stone free rate, repeat treatment rate, patients' satisfaction, incidence of postoperative complications, operation time and hospital stays between ESWL treatment cases and URS treatment cases. But in the sample sizes analysis, there were no significant differences of the post-treatment stone free rate and repeat treatment rate when the sample sizes were less than 100.
CONCLUSIONS: Compared to the ureteroscopic lithotripsy treatment, extracorporeal shock wave lithotripsy treatment provided a significantly lower post-treatment stone free rate, but it also obviously brought out less postoperative complications, shorter operation time and hospital stays.
Acta Cir Bras. 2014 May;29(5):346-52.
Comments 1
This is an article that needs some attention because it is a meta-analysis on results from 13 comparative studies between SWL and URS in 998 and 1007 patients, respectively. As expected, and in accordance with numerous studies in the literature, the stone-free rate was lower (18%) and the re-treatment rate higher in the SWL-treated group.
That patients were more satisfied with URS is a surprising finding that is different from that reported in some publications and neither a consistent finding in the reports included in this meta-analysis. Such an outcome might probably be explained by the way in which the responsible urologist presented the treatment outcome to the patient.
One important notation is that patients treated with SWL had a 37% lower risk of complications and significantly shorter hospital stay.
There now seems to be little need of further meta-analyses like this until there is a significant improvement in SWL technology. Detailed analysis of the outcome is hampered by the lack of information on the skill and experience of the SWL operator. In most reports it is obvious that there are different requirements in this regard between the SWL operator and the endoscopist.