Abstract
ObjectivesTo perform a systematic review and network meta-analysis of randomized controlled trials (RCTs) to determine the optimal shock wave lithotripsy (SWL) frequency range for treating urinary stones, i.e., high-frequency (100–120 waves/minute), intermediate-frequency (80–90 waves/minute), and low-frequency (60–70 waves/minute) lithotripsy.Materials and MethodsRelevant RCTs were identified from electronic databases for meta-analysis of SWL success and complication rates. Using pairwise and network meta-analyses, comparisons were made by qualitative and quantitative syntheses. Outcome variables are provided as odds ratios (ORs) with 95% confidence intervals (CIs).ResultsThirteen articles were included in the qualitative and quantitative synthesis using pairwise and network meta-analyses. On pairwise meta-analyses, comparable inter-study heterogeneity was observed for the success rate. On network meta-analyses, the success rates of low- (OR 2.2; 95% CI 1.5–2.6) and intermediate-frequency SWL (OR 2.5; 95% CI 1.3–4.6) were higher than high-frequency SWL. Forest plots from the network meta-analysis showed no significant differences in the success rate between low-frequency SWL versus intermediate-frequency SWL (OR 0.87; 95% CI 0.51–1.7). There were no differences in complication rate across different SWL frequency ranges. By rank-probability testing, intermediate-frequency SWL was ranked highest for success rate, followed by low-frequency and high-frequency SWL. Low-frequency SWL was also ranked highest for low complication rate, with high- and intermediate-frequency SWL ranked lower.ConclusionsIntermediate- and low-frequency SWL have better treatment outcomes than high-frequency SWL when considering both efficacy and complication.
Highlights
Since the introduction of shock wave lithotripsy (SWL) in the early 1980s, SWL has become a safe and accepted treatment modality for most intra-renal stones and many ureteral stones [1]
On pairwise meta-analyses, comparable inter-study heterogeneity was observed for the success rate
On network meta-analyses, the success rates of low- and intermediate-frequency SWL were higher than high-frequency SWL
Summary
Since the introduction of shock wave lithotripsy (SWL) in the early 1980s, SWL has become a safe and accepted treatment modality for most intra-renal stones and many ureteral stones [1]. Despite the popular use of SWL, controversy remains regarding its success rate and the optimal shock wave (SW) frequency to achieve stone-free status. In vitro and animal studies have demonstrated that stone disintegration is influenced by the rate of SW administration, and slowing the rate to less than 120 SW/minute may improve stone fragmentation [2,3]. We performed a systematic review and network meta-analysis of RCTs to decide the optimal SW frequency range for disintegrating urinary stones by SWL. Frequency ranges were defined as high-frequency (100–120 SWs/minute), intermediate-frequency (80–90 SWs/minute), and low-frequency (60–70 SWs/minute)
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