Abstract
To re-evaluated the clinic efficacy of ureteroscopic lithotripsy (URS) and extracorporeal shock wave lithotripsy (ESWL) on ureteral calculi with Cochrane systematic reviews in this paper. We searched clinical randomized controlled trials and prospective controlled trials in databases such as Cochrane library, Medline, Springer, Elsevier Science Direct, PubMed. Pooled estimate of risk ratios (RRs), standard mean difference (SMD) with 95% confidence intervals (CIs) were used as measure of effect sizes. Summary effect estimates were also stratified by sample size, study design and study region. The overall effect sizes were derived using a random-effects model or fixed-effects model when appreciated, and meta-analysis were conducted with software RewMan 5.0. The meta-analysis suggested that there were significant differences of post-treatment stone free rate, repeat treatment rate, patients' satisfaction, incidence of postoperative complications, operation time and hospital stays between ESWL treatment cases and URS treatment cases. But in the sample sizes analysis, there were no significant differences of the post-treatment stone free rate and repeat treatment rate when the sample sizes were less than 100. Compared to the ureteroscopic lithotripsy treatment, extracorporeal shock wave lithotripsy treatment provided a significantly lower post-treatment stone free rate, but it also obviously brought out less postoperative complications, shorter operation time and hospital stays.
Highlights
The presence of calculi in the urinary system is defined as urolithiasis, which represents the symptomatic manifestation of various metabolic disturbances, caused by a variety of pathological factors and their interaction[1]
Studies were included in the meta-analysis if they met the following criteria: (1) research papers publicly published abroad; (2) research objects were adult patients with ureteral diseases definitely diagnosed by imaging; (3) the study design were clinical prospective study; (4) studies should include treatments of ureteroscopic lithotripsy (URS) and extracorporeal shock wave lithotripsy (ESWL); (5) data should be integrity, and the number of cases in different treatment groups as well as cases finished the trials should be explicit; (6) observation index should include authors, published journals and time, patients quantity and their operation time, hospital stays, rate of stone free post treatment, rate of repeat treatment and postoperative complications
It is well known that ESWL and URS are the main techniques in treating ureteral calculi
Summary
The presence of calculi in the urinary system is defined as urolithiasis, which represents the symptomatic manifestation of various metabolic disturbances, caused by a variety of pathological factors and their interaction[1]. In Middela et al.[9] study, ESWL was demonstrated an effective and minimally invasive method for treating ureteral stones. While Hong and Park demonstrated that despite the liberal use of ESWL, ureteroscopic lithotripsy was still the preferred treatment modality for managing ureter stones at many hospitals and achieves an immediate stone-free state in a high percent of patients[10]. It is still controversial which treatment is clinical preferred
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