Effectiveness of pneumatic versus laser lithotripsy for upper tract urolithiasis - a systematic review and meta-analysis

Abstract

Introduction: This meta-analysis compares the efficacy and safety of laser lithotripsy (LL) and pneumatic lithotripsy (PL) for upper tract urolithiasis.

Methods: A systematic search of MEDLINE via PubMed, Embase, and the Cochrane Library identified trials comparing LL and PL. Primary outcomes included stone-free rate, operative time, and complications. A random-effects model was used, and heterogeneity was assessed using I² statistics.

Results: The systematic literature search identified 6420 studies of which 43 fulfilled the inclusion criteria. The studies reported data from 7,377 patients. Random effect meta-analysis for stone free rate included data from 36 studies and yielded statistically significant higher stone free rates for LL with a pooled OR=2.19 (95% Confidence Interval (CI)=1.63-2.94, p<0.001). Heterogeneity was substantial (I²= 62%; p<0.01). Random effect meta-analysis for operative time included data from 31 studies and yielded no statistically significant difference in operative time with a pooled MD=-1.09 minutes (95% CI=-4.39-2. 20, p=0.5161). Heterogeneity was considerable (I²= 98%; p<0.01). Random effect meta-analysis for complications included data from 14 studies and yielded statistically significant fewer complications for LL with a pooled OR=0.68 (95% CI=0.48-0.96, p=0.0276). Heterogeneity was limited (I²= 27%; p=0.17).

Conclusions: LL might be superior to PL in upper tract urolithiasis therapy.