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Meta-Analysis
. 2016 Jul-Aug;42(4):645-54.
doi: 10.1590/S1677-5538.IBJU.2015.0696.

Semi-rigid ureteroscopic lithotripsy versus laparoscopic ureterolithotomy for large upper ureteral stones: a meta - analysis of randomized controlled trials

Fabio C M Torricelli  1   2 , Manoj Monga  2 , Giovanni S Marchini  1 , Miguel Srougi  1 , William C Nahas  1 , Eduardo Mazzucchi  1
Affiliations
Meta-Analysis

Semi-rigid ureteroscopic lithotripsy versus laparoscopic ureterolithotomy for large upper ureteral stones: a meta - analysis of randomized controlled trials

Fabio C M Torricelli et al. Int Braz J Urol. 2016 Jul-Aug.

Abstract

Introduction: To provide a systematic review and meta-analysis of randomized controlled trials (RCT) comparing semi-rigid ureteroscopic lithotripsy (URS) with laparoscopic ureterolithotomy (LU) for the treatment of the large proximal ureteral stone.

Materials and methods: A systematic literature review was performed in June 2015 using the PubMed, Scopus, and Web of Science databases to identify relevant studies. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria.

Results: Six RCT including 646 patients were analyzed, 325 URS cases (50.3%) and 321 LU cases (49.7%). URS provided a significantly shorter operative time (weighted mean difference [WMD] = -31.26 min; 95%CI -46.88 to -15.64; <0.0001) and length of hospital stay (WMD = -1.48 days; 95%CI -2.78 to -0.18; p=0.03) than LU. There were no significant differences in terms of overall complications (OR = 0.78; 95%CI 0.21-2.92; p=0.71) and major complications - Clavien ≥3 - (OR = 1.79; 95%CI 0.59-5.42; p=0.30). LU led to a significantly higher initial stone-free rate (OR = 8.65; 95%CI 4.18-17.91; p<0.00001) and final stone-free rate (OR = 6.41; 95%CI 2.24-18.32; p=0.0005) than URS. There was a significantly higher need for auxiliary procedures in URS cases (OR = 6.58; 95%CI 3.42-12.68; p<0.00001).

Conclusions: Outcomes with LU for larger proximal ureteral calculi are favorable compared to semi-rigid URS and should be considered as a first-line alternative if flexible ureteroscopy is not available. Utilization of flexible ureteroscopy in conjunction with semi-rigid ureteroscopy may impact these outcomes, and deserves further systematic evaluation.

Keywords: Laparoscopy; Lithotripsy; Ureteroscopy.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-analysis flow of study selection.
Figure 2
Figure 2. Forest plot of operative time (min).
Figure 3
Figure 3. Forest plot of length of hospital stay (days).
Figure 4
Figure 4. Forest plot of overall postoperative complications.
Figure 5
Figure 5. Forest plot of major postoperative complications.
Figure 6
Figure 6. Forest plot of initial stone-free rate.
Figure 7
Figure 7. Forest plot of final stone-free rate.
Figure 8
Figure 8. Forest plot of need for auxiliary procedures.
See this image and copyright information in PMC

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