Zheng C et al, 2015: Extracorporeal shock wave lithotripsy versus retrograde intrarenal surgery for treatment for renal stones 1-2 cm: a meta-analysis.
Zheng C, Yang H, Luo J, Xiong B, Wang H, Jiang Q.
Department of Urology, The People's Hospital of Bishan District, Bishan, Chongqing, 402760, China.
Department of Urology, Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400016, China.
This study is to evaluate the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) versus retrograde intrarenal surgery (RIRS) for the treatment for renal calculi 1-2 cm. PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the Chinese Biomedical
Literature Database were researched and hand-searched for relevant congress abstracts and journals about RIRS and ESWL for the treatment for 1- to 2-cm renal stones. The retrieval time ended in September 2014. The related trials met the inclusion criteria were included in the meta-analysis. Two reviewers independently assessed the quality of all included studies, and meta-analysis was performed with RevMan 5.2. Seven literatures were retrieved, including 983 patients. The meta-analysis results showed that, compared to RIRS group, the patients in ESWL group had the following features:(1) the stone-free rate [relative risk (RR) 0.86; 95 % confidence interval (CI) 0.77-0.95, P = 0.005] was significantly different between two groups; (2) The retreatment rate of RIRS group was lower (RR 8.12; 95 % CI 4.77-13.83, P < 0.00); (3) The complications were not significantly different between two groups (Grade I RR 1.06; 95 % CI 0.67-1.69, P = 0.80; Grade II RR 0.75; 95 % CI 0.29-1.91, P = 0.54; Grade III RR 0.86; 95 % CI 0.26-2.86, P = 0.80). Compared to ESWL, our results showed that RIRS provided significantly higher stone-free rate and lower retreatment rate and without increase in the incidence of complications. However, further randomized trials are needed to confirm these findings.
Urolithiasis. 2015 Jul 26. [Epub ahead of print]
The abstracts’ last sentence “However, further randomized trials are needed to confirm these findings” is frequently found at the end of original papers on this topic. It is somehow disappointing to find it also at the end of a meta-analysis
“The present meta-analysis has a number of limitations. First, only seven trials met the inclusion criteria, and the included literatures were all small sample size. … There may be possible publication bias. Third, some [4 of 7] of the studies included in this meta-analysis are CCTs, and these studies were more likely to result in various kinds of bias. As only a few studies with small study populations were available, we believe that more results with high-quality trials, more rigorous, large sample, long-term randomized controlled trials should be provided to update this study.”
The real life situation is clearly in favour of RIRS and MiniPCNL and ESWL has to struggle hard and to come up with something new to compete.