Yang C et al, 2016: Comparison of YAG Laser Lithotripsy and Extracorporeal Shock Wave Lithotripsy in Treatment of Ureteral Calculi: A Meta-Analysis.
Yang C, Li S, Cui Y.
The National Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China.
OBJECTIVE: To evaluate the clinical efficiency and safety of ureteroscopy lithotripsy (URSL) with holmium laser technology and extracorporeal shock wave lithotripsy (ESWL) on ureteral calculi using systematic reviews.
METHODS: Randomized controlled trials and prospective controlled trials accorded with inclusion among PubMed Database, EmBase Database, Cochrane Library and China National Knowledge Infrastructure were collected. Review Manager 5.0 was adopted to estimate the effects of the results among selected articles. Forest plots, sensitivity analysis and bias analysis for the articles included were also conducted. Pooled estimate of risk ratios and standard mean difference (SMD) with 95% CIs were used as measures of effect sizes.
RESULTS: Finally 1,770 patients were included in the 14 studies, which eventually satisfied the eligibility criteria. The number of patients in URSL group and ESWL group were 885 and 885, respectively. The results of heterogeneity test suggested that complication events (RR 1.12 (95% CI 0.63-2.00), p = 0.70), hospital days (SMD = -0.08 (95% CI -1.14 to 0.98), p = 0.88) and efficiency quotient (RR 1.31 (95% CI 0.96-1.80), p = 0.09) were insignificantly different, while the stone-free rate (RR 1.15 (95% CI 1.06-1.26), p = 0.002) and operation time (SMD = -2.27 (95% CI -3.42 to -1.11), p = 0.0001) between ESWL and URSL were significantly different.
CONCLUSION: Although both URSL and ESWL have its own advantages and drawbacks, URSL is relatively a more efficient and safe method to treat ureteric stones, since it has shorter operation time and a better stone-free rate.
Urol Int. 2016 Nov 1. [Epub ahead of print]
This is another one of several meta-analyses comparing SWL and RIRS; in this report results with ureteral stones. Patients were treated between 1999 and 2016. Different lithotripters were used and it is not mentioned to which extent repeated treatments were accepted. The stone free rate was 78% for SWL and 89% for RIRS (with Ho-YAG laser disintegration). The report is of limited value because stone position in the ureter is unknown and there are no details given on the type of complications that occurred.