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Urolithiasis
Published in: Urolithiasis 4/2016

01-08-2016 | Original Paper

Flexible ureterorenoscopy (F-URS) with holmium laser versus extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stone <2 cm: a meta-analysis

Authors: Yuanyuan Mi, Kewei Ren, Haiyan Pan, Lijie Zhu, Sheng Wu, Xiaoming You, Hongbao Shao, Feng Dai, Tao Peng, Feng Qin, Jian Wang, Yi Huang

Published in: Urolithiasis | Issue 4/2016

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Abstract

The objective of the study was to systematically review the efficacy and safety of flexible ureterorenoscopy (F-URS) with holmium laser versus extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal stone <2 cm. A systematic literature review was performed in April 2015 using the PubMed, Embase, Web of Science and the Chinese Biomedical Literature (CNKI and Wanfang) databases to identify relevant studies. All clinical trials were retrieved and their included references investigated. Two reviewers independently assessed the quality of all included studies, and the eligible studies were included and analyzed using the RevMan 5.3 software. Six prospective randomized comparison trials and eight retrospective comparison trials were included, involving a total of 2348 patients. For renal stone 1–2 cm, F-URS technique provided a significantly higher stone-free rate (SFR) [weighted mean difference (WMD) = 2.35, 95 % confidence interval (CI) 1.65–3.34, P < 0.00001], lower auxiliary procedure rate (APR) [odds ratio (OR) 0.33, 95 % CI 0.22–0.50, P < 0.00001] and lower retreatment rate (RR) (OR 0.07, 95 % CI 0.01–0.37, P = 0.002). Similar results were found in the lower pole stone for 1–2 cm subgroup. For renal stone <1 cm, F-URS technique also showed a significantly higher SFR than ESWL (WMD = 2.13, 95 % CI 1.13–4.00, P = 0.02). F-URS is associated with higher SFR, lower APR and RR than ESWL. F-URS is a safe and effective procedure. It can successfully treat patients with stones for 1–2 cm, especially for lower pole stone, without increasing complications, operative time and hospital stay. F-URS can be used as an alternative treatment to ESWL in selected cases with larger renal stones. However, further randomized trials are needed to confirm these findings.
Literature
1.
Litwin MS, Saigal C (2012) Urologic diseases in America. US Government Printing Office, Washington, DC
2.
Taylor EN, Stampfer MJ, Curhan GC (2005) Obesity, weight gain, and the risk of kidney stones. JAMA 293:455–462CrossRefPubMed
3.
Abate N, Chandalia M, Cabo-Chan AV Jr, Moe OW, Sakhaee K (2004) The metabolic syndrome and uric acid nephrolithiasis: novel features of renal manifestation of insulin resistance. Kidney Int 65:386–392CrossRefPubMed
4.
Ghani KR, Sammon JD, Karakiewicz PI, Sun M, Bhojani N, Sukumar S et al (2013) Trends in surgery for upper urinary tract calculi in the USA using the Nationwide Inpatient Sample: 1999–2009. BJU Int 112:224–230CrossRefPubMed
5.
Lee MC, Bariol SV (2011) Evolution of stone management in Australia. BJU Int 108:S29–S33CrossRef
6.
Ordon M, Urbach D, Mamdani M, Saskin R, D’A Honey RJ RJ et al (2014) The surgical management of kidney stone disease: a population based time series analysis. J Urol 192:1450–1456CrossRefPubMed
7.
Na YQ, Ye ZQ, Sun YH, Sun G (2013) The guideline for diagnosis and treatment of urology disease 2014. People’s Medical Publishing House, Beijing
8.
Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A et al (2014) Guidelines on urolithiasis. European Association of Urology, The Netherlands
9.
El-Nahas AR, Ibrahim HM, Youssef RF, Sheir KZ (2012) Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for treatment of lower pole stones of 10–20 mm. BJU Int 110:898–902CrossRefPubMed
10.
Pearle MS, Lingeman JE, Leveillee R, Kuo R, Preminger GM et al (2008) Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less. J Urol 179:S69–S73CrossRefPubMed
11.
Aboutaleb H, El-Shazly M, Badr Eldin M (2012) Lower pole midsize (1–2 cm) calyceal stones: outcome analysis of 56 cases. Urol Int 89:348–354CrossRefPubMed
12.
Cecen K, Karadag MA, Demir A, Bagcioglu M, Kocaaslan R et al (2014) Flexible Ureterorenoscopy versus Extracorporeal Shock Wave Lithotripsy for the treatment of upper/middle calyx kidney stones of 10–20 mm: a retrospective analysis of 174 patients. Springerplus 3:557CrossRefPubMedPubMedCentral
13.
14.
Clark HD, Wells GA, Huet C, McAlister FA, Salmi LR et al (1999) Assessing the quality of randomized trials: reliability of the Jadad scale. Control Clin Trials 20:448–452CrossRefPubMed
15.
16.
17.
Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22:719–748PubMed
18.
19.
Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928CrossRefPubMedPubMedCentral
20.
Singh BP, Prakash J, Sankhwar SN, Dhakad U, Sankhwar PL et al (2014) Retrograde intrarenal surgery vs extracorporeal shock wave lithotripsy for intermediate size inferior pole calculi: a prospective assessment of objective and subjective outcomes. Urology 83:1016–1022CrossRefPubMed
21.
Kumar A, Kumar N, Vasudeva P, Kumar Jha S, Kumar R et al (2015) A prospective, randomized comparison of shock wave lithotripsy, retrograde intrarenal surgery and miniperc for treatment of 1 to 2 cm radiolucent lower calyceal renal calculi: a single center experience. J Urol 193:160–164CrossRefPubMed
22.
Mokhless IA, Abdeldaeim HM, Saad A, Zahran AR (2014) Retrograde intrarenal surgery monotherapy versus shock wave lithotripsy for stones 10 to 20 mm in preschool children: a prospective, randomized study. J Urol 191:1496–1499CrossRefPubMed
23.
Sener NC, Bas O, Sener E, Zengin K, Ozturk U et al (2015) Asymptomatic lower pole small renal stones: shock wave lithotripsy, flexible ureteroscopy, or observation? A prospective randomized trial. Urology 85:33–37CrossRefPubMed
24.
Sener NC, Imamoglu MA, Bas O, Ozturk U, Goktug HN et al (2014) Prospective randomized trial comparing shock wave lithotripsy and flexible ureterorenoscopy for lower pole stones smaller than 1 cm. Urolithiasis 42:127–131CrossRefPubMed
25.
Kumar A, Vasudeva P, Nanda B, Kumar N, Das MK et al (2015) A prospective randomized comparison between shock wave lithotripsy and flexible ureterorenoscopy for lower caliceal stones ≤2 cm: a single-center experience. J Endourol 29:575–579CrossRefPubMed
26.
Koo V, Young M, Thompson T, Duggan B (2011) Cost-effectiveness and efficiency of shockwave lithotripsy vs flexible ureteroscopic holmium: yttrium–aluminium–garnet laser lithotripsy in the treatment of lower pole renal calculi. BJU Int 108:1913–1916CrossRefPubMed
27.
Vilches RM, Aliaga A, Reyes D, Sepulveda F, Mercado A et al (2015) Comparison between retrograde intrarenal surgery and extracorporeal shock wave lithotripsy in the treatment of lower pole kidney stones up to 15 mm. Prospective, randomized study. Actas Urol Esp 39:236–242CrossRefPubMed
28.
Kiremit MC, Guven S, Sarica K, Ozturk A, Buldu I et al (2015) Contemporary management of medium-sized (10–20 mm) renal stones: a retrospective multicenter observational study. J Endourol 29:838–843CrossRefPubMed
29.
Ozturk U, Sener NC, Goktug HN, Nalbant I, Gucuk A et al (2013) Comparison of percutaneous nephrolithotomy, shock wave lithotripsy, and retrograde intrarenal surgery for lower pole renal calculi 10–20 mm. Urol Int 91:345–349CrossRefPubMed
30.
Xu YX, Duan JL, Zhou XJ (2014) Comparison of shock wave lithotripsy, flexible ureterorenoscopy and percutaneous nephrolithotripsy on renal pelvis stones between 1 and 2 cm. Int J Urol Nephrol 34:826–828
31.
Bas O, Bakirtas H, Sener NC, Ozturk U, Tuygun C et al (2014) Comparison of shock wave lithotripsy, flexible ureterorenoscopy and percutaneous nephrolithotripsy on moderate size renal pelvis stones. Urolithiasis 42:115–120CrossRefPubMed
32.
Resorlu B, Unsal A, Ziypak T, Diri A, Atis G et al (2013) Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones. World J Urol 31:1581–1586CrossRefPubMed
33.
34.
Raman JD, Pearle MS (2008) Management options for lower pole renal calculi. Curr Opin Urol 18:214–219CrossRefPubMed
35.
Wu CF, Shee JJ, Lin WY, Lin CL, Chen CS (2004) Comparison between extracorporeal shock wave lithotripsy and semirigid ureterorenoscope with holmium:YAG laser lithotripsy for treating large proximal ureteral stones. J Urol 172:1899–1902CrossRefPubMed
36.
Sampaio FJ, Aragao AH (1994) Limitations of extracorporeal shockwave lithotripsy for lower caliceal stones: anatomic insight. J Endourol 8:241–247CrossRefPubMed
37.
El-Nahas AR, El-Assmy AM, Mansour O, Sheir KZ (2007) A prospective multivariate analysis of factors predicting stone disintegration by extracorporeal shock wave lithotripsy: the value of high-resolution noncontrast computed tomography. Eur Urol 51:1688–1693CrossRefPubMed
38.
Abe T, Akakura K, Kawaguchi M, Ueda T, Ichikawa T et al (2005) Outcomes of shockwave lithotripsy for upper urinary-tract stones: a large-scale study at a single institution. J Endourol 19:768–773CrossRefPubMed
39.
Egilmez T, Tekin MI, Gonen M, Kilinc F, Goren R et al (2007) Efficacy and safety of a new-generation shockwave lithotripsy machine in the treatment of single renal or ureteral stones: experience with 2670 patients. J Endourol 21:23–27CrossRefPubMed
40.
Tan YM, Yip SK, Chong TW, Wong MY, Cheng C et al (2002) Clinical experience and results of ESWL treatment for 3,093 urinary calculi with the Storz Modulith SL 20 lithotripter at the Singapore general hospital. Scand J Urol Nephrol 36:363–367CrossRefPubMed
41.
Müller-Mattheis VG, Schmale D, Seewald M, Rosin H, Ackermann R (1991) Bacteremia during extracorporeal shock wave lithotripsy of renal calculi. J Urol 146:733–736PubMed
42.
Skolarikos A, Alivizatos G, de la Rosette J (2006) Extracorporeal shock wave lithotripsy 25 years later: complications and their prevention. Eur Urol 50:981–990CrossRefPubMed
43.
Maker V, Layke J (2004) Gastrointestinal injury secondary to extracorporeal shock wave lithotripsy: a review of the literature since its inception. J Am Coll Surg 198:128–135CrossRefPubMed
44.
Bozkurt OF, Resorlu B, Yildiz Y, Can CE, Unsal A (2011) Retrograde intrarenal surgery versus percutaneous nephrolithotomy in the management of lower-pole renal stones with a diameter of 15 to 20 mm. J Endourol 25:1131–1135CrossRefPubMed
45.
Geavlete P, Georgescu D, Niţă G, Mirciulescu V, Cauni V (2006) Complications of 2735 retrograde semirigid ureteroscopy procedures: a single-center experience. J Endourol 20:179–185CrossRefPubMed
46.
Hussain M, Acher P, Penev B, Cynk M (2011) Redefining the limits of flexible ureterorenoscopy. J Endourol 25:45–49CrossRefPubMed
47.
Tefekli A, Ali Karadag M, Tepeler K, Sari E, Berberoglu Y et al (2008) Classification of percutaneous nephrolithotomy complications using the modified clavien grading system: looking for a standard. Eur Urol 53:184–190CrossRefPubMed
Metadata
Title
Flexible ureterorenoscopy (F-URS) with holmium laser versus extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stone <2 cm: a meta-analysis
Authors
Yuanyuan Mi
Kewei Ren
Haiyan Pan
Lijie Zhu
Sheng Wu
Xiaoming You
Hongbao Shao
Feng Dai
Tao Peng
Feng Qin
Jian Wang
Yi Huang
Publication date
01-08-2016
Publisher
Springer Berlin Heidelberg
Published in
Urolithiasis / Issue 4/2016
Print ISSN: 2194-7228
Electronic ISSN: 2194-7236
DOI
https://doi.org/10.1007/s00240-015-0832-y

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