Comparison of two transurethral endoscopic modalities used in treatment of bladder stones: a systematic review and meta-analysis for randomized controlled trials

Abstract

Background: A systematic review and meta-analysis was conducted to compare the safety and efficiency of nephroscope and cystoscope in transurethral cystolithotripsy (TUCL) for bladder stones. Methods: PubMed, Web of Science, Embase, EBSCO, and the Cochrane library databases (updated January 2021) were searched for studies that assessed the efficacy of different types of endoscopes in TUCL cases. The search strategy and study selection process was managed according to the PRISMA statement. Results: Five randomized controlled trials were included in the meta-analysis. Our result showed no significant differences in the stone free rate (SFR) across the studies (RR= 1.00; CI 0.98–1.02, p = 1.00). The study heterogeneity (I2 = 0%, P = 1.00) was not significant as all patients were rendered stone free. Using nephroscope can significantly shorten operation times compared to the use of cystoscopy (RR= -26.26; CI -35.84 – -16.68, p < 0.00001) with significant heterogeneity (I2 =87%, p < 0.00001). There was no significant difference between mean urethral entries (RR= 0.66; CI -0.71 – -2.04, p = 0.35), hospitalization (MD = 0.08, 95% CI = -0.07-0.23; P=0.31) and the total complication rate (RR = 1.37, 95% CI = 0.47-4.00, p=0.56). Conclusions: This systematic review demonstrated that using are highly efficient approaches in the clearance of bladder stones and result in a low rate of complication and short hospitalization times. The mean urethral entries are dependent on the treatment method for large stone fragments. However, using nephroscope can significantly reduce operation times. Key words: bladder stones; transurethral; endoscopic treatments; cystoscope; nephroscope