Comparison of stone-free rates following shock wave lithotripsy, percutaneous nephrolithotomy, and retrograde intrarenal surgery for treatment of renal stones: A systematic review and network meta-analysis.

Doo Yong Chung,Kang Su Cho,Won Sik Jeong,Hae Do Jung,Dong Hyuk Kang,Joo Yong Lee,Jong Kyou Kwon,Seon Heui Lee,Girish Chandra Bhatt

doi:10.1371/journal.pone.0211316

Abstract

ObjectivesTo perform a systematic review and network meta-analysis comparing stone-free rates following retrograde intrarenal surgery (RIRS), extracorporeal shock wave lithotripsy (SWL), and percutaneous nephrolithotomy (PCNL) treatments of renal stones.Materials and methodsClinical trials comparing RIRS, SWL, and PCNL for treatment of renal stones were identified from electronic databases. Stone-free rates for the procedures were compared by qualitative and quantitative syntheses (meta-analyses). Outcome variables are shown as risk ratios (ORs) with 95% credible intervals (CIs).ResultsA total of 35 studies were included in this network meta-analysis of success and stone-free rates following three different treatments of renal stones. Six studies compared PCNL versus SWL, ten studies compared PCNL versus RIRS, fourteen studies compared RIRS versus SWL, and five studies compared PCNL, SWL, and RIRS. The quality scores within subscales were relatively low-risk. Network meta-analyses indicated that stone-free rates of RIRS (OR 0.38; 95% CI 0.22–0.64) and SWL (OR 0.12; 95% CI 0.067–0.19) were lower than that of PCNL. In addition, stone-free rate of SWL was lower than that of RIRS (OR 0.31; 95% CI 0.20–0.47). Stone free rate of PCNL was also superior to RIRS in subgroup analyses including ≥ 2 cm stone (OR 4.680; 95% CI 2.873–8.106), lower pole stone (OR 1.984; 95% CI 1.043–2.849), and randomized studies (OR 2.219; 95% CI 1.348–4.009). In rank-probability test, PCNL was ranked as No. 1 and SWL was ranked as No. 3.ConclusionsPCNL showed the highest success and stone-free rate in the surgical treatment of renal stones. In contrast, SWL had the lowest success and stone-free rate.

Highlights

Urinary tract calculi, one of the most common benign urological diseases, is seen in 12% of patients and has a recurrence rate of approximately 50% [1, 2]
Network meta-analyses indicated that stone-free rates of retrograde intrarenal surgery (RIRS) and shock wave lithotripsy (SWL) were lower than that of percutaneous nephrolithotomy (PCNL)
Stone free rate of PCNL was superior to RIRS in subgroup analyses including 2 cm stone, lower pole stone

Summary

Introduction

One of the most common benign urological diseases, is seen in 12% of patients and has a recurrence rate of approximately 50% [1, 2]. Factors that may play an important role in the increase of urinary tract stone disease include increases in diagnosis of metabolic syndrome, lifestyle changes, dehydration, lack of water intake, and low urine volume [3]. In comparison with PCNL and RIRS, SWL plays a pivotal role in the treatment of urinary tract stones because it is the only interventional treatment with non-invasive properties [7]. Though prospective studies and a meta-analysis of the three treatments along with their advantages and disadvantages have been reported, a network meta-analysis that compares all three treatments at the same time has not yet been reported. We performed a systematic review and a network meta-analysis analysis that compares the success as well as the stone-free rates of SWL, RIRS, and PCNL

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Conclusion