Comparison of efficacy and safety of various management options for large upper ureteric stones a systematic review and network meta-analysis

Abstract

To compare the safety and efficacy of various surgical modalities to manage large (> 1 cm) upper ureter stones. Systematic literature search was conducted to include all randomized studies comparing various treatment options for large (> 1 cm) upper ureteric stones. This review included 13 randomized studies with 1871 patients. Laparoscopic ureterolithotomy (LUL) and percutaneous nephrolithotomy (PNL) were superior to ureteroscopy (URS) and shockwave lithotripsy (SWL) for stone-free rates and need for auxiliary treatments. LUL and PNL were equally effective for stone-free rates and the need for auxiliary treatments. According to SUCRA values for stone-free rates and the need for auxiliary treatments, LUL was the best, followed by PNL. For the duration of surgery, there was no significant difference among all the techniques on network analyses, and SWL was the best according to SUCRA values. Length of hospital stay was significantly shorter for URS than LUL and PNL from network analysis, but there was no significant difference for the rest of the comparisons. Overall complications were similar in all the groups. According to the CINeMa approach, the confidence rating ranged from “very low” to “moderate” for various comparisons. LUL followed by PNL is the most efficacious treatment modality for upper ureteric stones compared to SWL and URS in terms of stone-free rates. However, due to the poor quality of included studies, further high-quality randomized studies are needed.

A meta-analysis: retrograde intrarenal surgery vs. percutaneous nephrolithotomy in children

“…This conclusion is essentially the same as in the meta-analysis by Sharma et al on adult kidney stones. However, these two studies included fewer RCTs, and their findings need more high-quality RCTs for validation ( 35 , 36 ). In the study by Gu et al, in contrast to micro-PCNL, RIRS had a higher SFR and more hemoglobin loss, and no differences were identified in hospitalization, fluoroscopy durations, or complication rates ( 37 ).…”

A Comparative Analysis between Flexible Ureteroscopic Lithotripsy and Tubeless Percutaneous Nephrolithotomy in the Treatment of >15 mm Non-Obstructing Proximal Ureteral Stones

“…The authors concluded that this study was plagued by the poor quality of included studies. Thus the choice of a treatment modality in a given situation will continue to depend upon patient-and surgeon-driven factors until a good-quality randomized controlled study comparing all the four surgical procedures for large upper ureteric stones comes up [26]. Another meta-analysis study was performed to investigate the safety and efficacy of minimally invasive surgical ureterolithotomy in comparision with URL for the treatment of large ureteric stones.…”

Comparison of laparoscopic ureterolithotomy and retrograde lithotripsy in the treatment of proximal ureteral stones

“…По тяжести осложнений (Clavien -Dindo ≥ III, в смысловом восприятии от лучшего к худшему): литотомия > ударно-волновая литотрипсия > уретероскопия > PNUL [5]. Аналогичные результаты получены и в ряде других работ, где большинство авторов отмечают высочайший рейтинг свободы от камней после уретеролитотомии, равный или близкий 100 % [8][9][10][11]. Подобные выводы сделаны при сравнении нефролапаксии с лапароскопической пиелолитотомией [12].…”