Abstract
To compare the safety and efficacy of various surgical modalities to manage large (> 1 cm) upper ureter stones. Systematic literature search was conducted to include all randomized studies comparing various treatment options for large (> 1 cm) upper ureteric stones. This review included 13 randomized studies with 1871 patients. Laparoscopic ureterolithotomy (LUL) and percutaneous nephrolithotomy (PNL) were superior to ureteroscopy (URS) and shockwave lithotripsy (SWL) for stone-free rates and need for auxiliary treatments. LUL and PNL were equally effective for stone-free rates and the need for auxiliary treatments. According to SUCRA values for stone-free rates and the need for auxiliary treatments, LUL was the best, followed by PNL. For the duration of surgery, there was no significant difference among all the techniques on network analyses, and SWL was the best according to SUCRA values. Length of hospital stay was significantly shorter for URS than LUL and PNL from network analysis, but there was no significant difference for the rest of the comparisons. Overall complications were similar in all the groups. According to the CINeMa approach, the confidence rating ranged from “very low” to “moderate” for various comparisons. LUL followed by PNL is the most efficacious treatment modality for upper ureteric stones compared to SWL and URS in terms of stone-free rates. However, due to the poor quality of included studies, further high-quality randomized studies are needed.
Highlights
To compare the safety and efficacy of various surgical modalities to manage large (> 1 cm) upper ureter stones
Antegrade percutaneous nephrolithotomy (PNL) is only used in specific situations such as the presence of large stone, impacted stone, simultaneous renal stones, failed URS or shockwave lithotripsy (SWL) and inability to obtain retrograde access
There is no level I data to advocate one treatment over another; selection of a particular treatment option depends on patient factors, surgeon factors, stone factors and anatomical factors
Summary
To compare the safety and efficacy of various surgical modalities to manage large (> 1 cm) upper ureter stones. There is no level I data to advocate one treatment over another; selection of a particular treatment option depends on patient factors (fitness for anesthesia, acceptability to invasive or less invasive options or acceptability to low stone free rate), surgeon factors (skills and experience), stone factors (size, location, impaction) and anatomical factors (solitary kidney, unavailability of retrograde access). This network meta-analysis aimed to combine direct and indirect evidence comparing the different surgical options for upper ureteric stones in terms of safety and efficacy
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
