SWL literature
Slider

Junbo L et al., 2019: Retrograde Intrarenal Surgery vs. Percutaneous Nephrolithotomy vs. Extracorporeal Shock Wave Lithotripsy for Lower Pole Renal Stones 10-20 mm : A Meta-analysis and Systematic Review

Junbo L, Yugen L, Guo J, Jing H, Ruichao Y, Tao W.
Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan, P.R. China. Department of Pathophysiology and Molecular Pharmacology, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.

Abstract

PURPOSE: To conduct a comprehensive meta-analysis of existing evidence to quantify and compare the safety and efficacy of PCNL, RIRS and ESWL for lower pole renal stones 10-20mm. MATERIALS AND METHODS: We conducted a systematic literature search in the EMBASE, MEDLINE, Cochrane databases and Google Scholar to identify relevant studies published in English up to May 2018. Literature reviewed included meta-analyses, and randomized and nonrandomized studies. The subject in the management of PCNL, RIRS and ESWL of studies being patients who had lower pole renal stones 10-20mm were selected. The odd ratio (OR) and mean difference (MD) with its 95% confidence interval (CI) using fixed-or-random-model were calculated to estimate the safety and efficacy of PCNL, RIRS and ESWL for lower pole renal stones 10-20mm. Two reviewers independently assessed the quality of all included studies, and the RevMan 5.3 software was used to analyze the included studies. RESULTS: Three randomized controlled trials and five retrospective case control studies were included, involving a total of 1615 patients in our meta-analysis. Our results suggest that, for lower pole renal stones 10-20mm, PCNL has a great advantage to RIRS (OR=1.95, 95% CI: 1.22-3.12, P =.005, I2 = 39%) and ESWL (OR=0.22, 95% CI: 0.15-0.34, P <.00001, I2 = 0%) in stone-free rate. Comparing PCNL (MD=-24.97, 95% CI:-40.90--9.04, P=.002, I2 = 76%) (MD=-2.43, 95% CI:-4.70--0.17, P=.04, I2 = 99%) and RIRS (MD=-15.39, 95% CI: -25.54--5.25, P=.003, I2 = 99%) (MD=-0.95, 95% CI: -1.29--0.61, P<.00001, I2 = 96%), ESWL owns some advantages in shorter operative time and hospital stay. Both of PCNL (OR=70.21, 95% CI: 25.01-197.11, P<.00001) (OR=4.01, 95% CI: 2.04-7.89, P<.0001) and RIRS (OR=32.31, 95% CI: 18.39-56.76, P<.00001, I2=0%) (OR=3.06, 95% CI: 1.94-4.84, P<.00001, I2=19%) have some strong points in lower retreatment rate and auxiliary procedure rate comparing ESWL, but no statistical significant difference is found between them (OR=0.46, 95% CI: 0.15-1.42, P =.18, I2=0%) (OR=0.75, 95% CI: 0.35-1.59, P =.45). About complication rate, there's no statistical significant difference found in PCNL (OR=1.42, 95%, CI: 0.91-2.21, P=.12, I2=0%), RIRS (OR=0.74, 95% CI: 0.51-1.07, P=.11, I2=30%) and ESWL (OR=0.41, 95%, CI:0.16-1.09, P=.07, I2=70%). CONCLUSION: Both of PCNL and RIRS offer a longer operative time, the lower retreatment rate and auxiliary procedure rate while PCNL has the longest hospital stay and the highest SFR. However, ESWL is confirmed to have the lowest SFR, the higher retreatment rate and auxiliary procedure rate, but a shorter operative time and the shortest hospital stay. The overall complication rates among the three therapies are comparable.
Urol J. 2019 Jan 1. doi: 10.22037/uj.v0i0.4681. [Epub ahead of print]

0
 

Commenti 1

Hans-Göran Tiselius il Mercoledì, 07 Agosto 2019 08:15

Currently there is a wide-spread and pronounced interest in meta-analyses and analyses of retrospective comparative studies in order to summarize the outcome of different treatment methods. The available modalities used to remove stones from the urinary tract are no exception. The increasing number of statistical analyses of this kind obviously is given priority over more extensive methodological development efforts and research.

The authors of this report focused on the outcome of SWL, PCNL and RIRS for treating stone (10-20 mm) in the lower calyx.

The overall-stone-free rates were 69.6 % for SWL, 90.9% for PCNL, and 84.8% for RIRS. These results are very similar to those in another recent report in which stones in all parts of the kidney were included [1]: 61.7% for SWL. 92.6% for PCNL and 84.6% for RIRS.
It is the reviewer’s opinion that we so far have sufficient information on stone-free rates with these three treatment techniques. In terms of SWL and in view of the authors’ conclusion that more RCTs or retrospective analyses are necessary, I think that such a step is justified only if and when there are some methodological changes or improvements; for instance in the way fragment elimination from the kidney can be facilitated.

Currently there is a wide-spread and pronounced interest in meta-analyses and analyses of retrospective comparative studies in order to summarize the outcome of different treatment methods. The available modalities used to remove stones from the urinary tract are no exception. The increasing number of statistical analyses of this kind obviously is given priority over more extensive methodological development efforts and research. The authors of this report focused on the outcome of SWL, PCNL and RIRS for treating stone (10-20 mm) in the lower calyx. The overall-stone-free rates were 69.6 % for SWL, 90.9% for PCNL, and 84.8% for RIRS. These results are very similar to those in another recent report in which stones in all parts of the kidney were included [1]: 61.7% for SWL. 92.6% for PCNL and 84.6% for RIRS. It is the reviewer’s opinion that we so far have sufficient information on stone-free rates with these three treatment techniques. In terms of SWL and in view of the authors’ conclusion that more RCTs or retrospective analyses are necessary, I think that such a step is justified only if and when there are some methodological changes or improvements; for instance in the way fragment elimination from the kidney can be facilitated.
Ospite
Mercoledì, 21 Agosto 2019
STORZ MEDICAL AG
Lohstampfestrasse 8
8274 Tägerwilen
Switzerland
Tel.: +41 (0)71 677 45 45
Fax: +41 (0)71 677 45 05

www.storzmedical.com