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Meta-Analysis
. 2017 Feb 9;12(2):e0171478.
doi: 10.1371/journal.pone.0171478. eCollection 2017.

Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis

Qing Wang  1 , Jiachao Guo  2 , Henglong Hu  1 , Yuchao Lu  1 , Jiaqiao Zhang  1 , Baolong Qin  1 , Yufeng Wang  1 , Zongbiao Zhang  1 , Shaogang Wang  1
Affiliations
Meta-Analysis

Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis

Qing Wang et al. PLoS One. .

Abstract

Object: To compare the safety and efficacy of rigid ureteroscopic lithotripsy (rigid URSL) and percutaneous nephrolithotomy (PCNL) in treating large proximal ureteral stones.

Methods: A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science databases was performed to find out relevant studies. After literature screening according to the predetermined inclusion and exclusion criteria, data of eligible studies was extracted and then a meta-analysis was conducted via RevMan 5.3 software.

Results: Five randomized controlled trials (RCTs), one prospective and four retrospective cohort studies involving 837 patients were included. Patients underwent rigid URSL were associated with shorter operation time (WMD, -23.66min; 95%CI, -45.00 to -2.32; p = 0.03), shorter hospital stay (WMD, -2.76d; 95%CI, -3.51 to -2.02; p< 0.00001), lower 3rd-day (RR, 0.73; 95%CI, 0.66 to 0.82; p < 0.00001) and 1st-month (RR, 0.82; 95%CI, 0.77 to 0.87; p < 0.00001) stone-free rate, higher risk of conversion to other surgical procedures (RR, 4.28; 95%CI, 1.93 to 9.46; p = 0.0003), higher incidence of migration (RR, 28.49; 95%CI, 9.12 to 89.00; p < 0.00001) and ureteral perforation (RR, 6.06; 95%CI, 1.80 to 20.44; p = 0.004), lower risk of fever (RR, 0.64; 95%CI, 0.42 to 0.97; p = 0.04), transfusion (RR, 0.19; 95%CI, 0.04 to 0.85; p = 0.03) and hematuria (RR, 0.38; 95%CI, 0.25 to 0.57; p < 0.0001). No significant difference was observed in terms of incidence of embolization, pain and ureterostenosis. When cohort studies or studies in which flexible ureteroscopy was used as an intraoperative auxiliary procedure were excluded, we both found that most of the results kept stable.

Conclusions: Both PCNL and rigid URSL are safe for patients with large proximal ureteral stones while PCNL is more effective in stone clearance.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of the literature search and studies selection.
Fig 2
Fig 2
(A) Risk of bias for randomized controlled trials. (B) Funnel plot of the operation time.
Fig 3
Fig 3
Forest plots of (A) operation time, (B) hospital stay.
Fig 4
Fig 4
Forest plots of (A) The 3rd-day stone-free rate, (B) The 1st-month stone-free rate with and without postoperative auxiliary SWL.
Fig 5
Fig 5. Forest plots of conversion, migration and ureteral perforation.
Fig 6
Fig 6. Forest plots of fever, transfusion, embolization, hematuria, pain, and ureterostenosis.
See this image and copyright information in PMC

References

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