A Meta-analysis of laparoscopic lithotomy and transurethral ureteroscope lithotripsy in the treatment of upper ureteral obstructive stones

Abstract

Objective To systematically compare the differences of clinical efficacy in the treatment of obstructive upper ureteral stones by laparoscopic lithotomy and transurethral ureteroscope lithotripsy. Methods The search strategy and the inclusion and exclusion criteria were made by two independent reviewers. We searched online PubMed, EMBASE, Cochrane Clinical Controlled Trials Database, China National Knowledge Infrastructure(CNKI), Wang fang and VIP citation database from the inception to September 2017 for randomized controlled trials(RCT)studies, which assessing the efficacy of laparoscopic ureterolithotomy (LU) and transurethral ureteroscope lithotripsy (URSL) for obstructive upper ureteral calculus. RevMan 5.3 software was used to perform a clinical meta-analysis of relevant literature data. Results Nine randomized controlled trials (RCTs) were included, a total of 994 cases of related patients, including LU group of 501 cases, URSL group of 493 cases. The results showed that URSL contained a shorter time of surgery[WMD=31.34 min, 95%CI(16.83, 45.85), P<0.01] and length of hospital stay[WMD=1.88 d, 95%CI(0.93, 2.82), P<0.01] compared with LU group. However, LU group had a lower postoperative complications[OR=0.47%, 95%CI(0.32, 0.70), P<0.01] and higher stone clearance rates[OR=6.63%, 95%CI(3.91, 11.25), P<0.01]than URSL group. Conclusions Although URSL requires less operative time and hospital stay than LU for the treatment of obstructive upper ureteral stones, the postoperative complication and stone clearance rate performance are poor in URSL. Key words: Ureteral Calculi; Laparoscopy; Ureteroscopy