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Meta-Analysis
. 2012 May 16;2012(5):CD006029.
doi: 10.1002/14651858.CD006029.pub4.

Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi

Omar M Aboumarzouk  1 , Slawomir G Kata, Francis X Keeley, Samuel McClinton, Ghulam Nabi
Affiliations
Meta-Analysis

Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi

Omar M Aboumarzouk et al. Cochrane Database Syst Rev. .

Abstract

Background: Ureteral stones frequently cause renal colic, and if left untreated, can lead to obstructive uropathy. Extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy, with or without intracorporeal lithotripsy, are the most common interventions used to treat ureteral stones. ESWL treatment is less invasive than ureteroscopy, but has some limitations such as a high retreatment rate, and is not available in all centres. Recent advances in ureteroscopy have increased success rates and reduced complication rates.

Objectives: To examine evidence from randomised controlled trials (RCTs) on the outcomes of ESWL or ureteroscopy in the treatment of ureteric calculi.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library Issue 2, 2011), MEDLINE (1966 to March 2011), EMBASE (1980 to March 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of articles and abstracts from conference proceedings, all without language restriction.

Selection criteria: RCTs that compared ESWL with ureteroscopic retrieval of ureteric stones were included in this review. Study participants were adults with ureteric stones requiring intervention. Published and unpublished sources were considered for inclusion.

Data collection and analysis: Three authors independently assessed study quality, risk of bias, and extracted data. Statistical analyses were performed using the random-effects model. Results were expressed as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous data, both with 95% confidence intervals (CI).

Main results: Seven RCTs (1205 patients) were included in the review. Stone-free rates were lower in patients who underwent ESWL (7 studies, 1205 participants: RR 0.84, 95% CI 0.73 to 0.96) but re-treatment rates were lower in ureteroscopy patients (6 studies, 1049 participants: RR 6.18, 95% CI 3.68 to 10.38. ESWL-treated patients had less need for auxiliary treatment (5 studies, 751 participants: RR 0.43, 95% CI 0.25 to 0.74; fewer complications (7 studies, 1205 participants: RR 0.54, 95% CI 0.33 to 0.88); and shorter length of hospital stay (2 studies, 198 participants: MD -2.55 days, 95% CI -3.24 to -1.86).Three studies adequately described the randomisation sequence, three studies were unclear on how they randomised, while one study had a high risk of selection bias. All the studies had an unclear risk of performance bias and detection bias, while all had a low risk of attrition bias, reporting bias, or other sources of bias identified.

Authors' conclusions: Compared with ESWL, ureteroscopic removal of ureteral stones achieves a greater stone-free state, but with a higher complication rate and longer hospital stay.

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Conflict of interest statement

  1. Omar M Aboumarzouk: None known

  2. Slawomir G Kata: None known

  3. Francis X Keeley: My clinical practice involves the use of both ESWL and ureteroscopy for stones. I have given lectures and received honoraria for teaching both for operating techniques and didactic educational material on kidney stones, upper tract tumors, PUJ obstruction and kidney cancer. I do not believe that any of the above affects my views on the need for a trial on the subject of ureteric stones, the assessment of the literature, nor how the trial should be run.

  4. Samuel McClinton: None known

  5. Ghulam Nabi: None known

Figures

1
1
Study flow diagram
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
1.1
1.1. Analysis
Comparison 1 ESWL versus ureteroscopy, Outcome 1 Stone‐free rate.
1.2
1.2. Analysis
Comparison 1 ESWL versus ureteroscopy, Outcome 2 Retreatment rate.
1.3
1.3. Analysis
Comparison 1 ESWL versus ureteroscopy, Outcome 3 Auxiliary procedures.
1.4
1.4. Analysis
Comparison 1 ESWL versus ureteroscopy, Outcome 4 Procedure‐related complications.
1.5
1.5. Analysis
Comparison 1 ESWL versus ureteroscopy, Outcome 5 Postoperative symptoms (flank pain/dysuria/haematuria).
1.6
1.6. Analysis
Comparison 1 ESWL versus ureteroscopy, Outcome 6 Requirement of analgesia.
1.7
1.7. Analysis
Comparison 1 ESWL versus ureteroscopy, Outcome 7 Postoperative symptoms (flank pain/dysuria/haematuria).
1.8
1.8. Analysis
Comparison 1 ESWL versus ureteroscopy, Outcome 8 Procedure time.
1.9
1.9. Analysis
Comparison 1 ESWL versus ureteroscopy, Outcome 9 Operating time.
1.10
1.10. Analysis
Comparison 1 ESWL versus ureteroscopy, Outcome 10 Hospital stay.
1.11
1.11. Analysis
Comparison 1 ESWL versus ureteroscopy, Outcome 11 Convalescence time.
1.12
1.12. Analysis
Comparison 1 ESWL versus ureteroscopy, Outcome 12 Recovery time.
1.13
1.13. Analysis
Comparison 1 ESWL versus ureteroscopy, Outcome 13 Day case procedure.
1.14
1.14. Analysis
Comparison 1 ESWL versus ureteroscopy, Outcome 14 Patient satisfaction.
1.15
1.15. Analysis
Comparison 1 ESWL versus ureteroscopy, Outcome 15 Patient satisfaction.
2.1
2.1. Analysis
Comparison 2 ESWL versus ureteroscopy subanalysis, Outcome 1 Auxiliary procedures.
See this image and copyright information in PMC

Update of

References

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References to other published versions of this review

Nabi 2006
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