MP66-15 EFFECTIVENESS OF SURGICAL MANAGEMENT FOR PEDIATRIC URETERAL STONES: SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

You have accessJournal of UrologyPediatrics: Testis, Varicocele & Stones1 Apr 2017MP66-15 EFFECTIVENESS OF SURGICAL MANAGEMENT FOR PEDIATRIC URETERAL STONES: SYSTEMATIC REVIEW AND META-ANALYSIS Hsin-Hsiao S. Wang, Ruiyang Jiang, J. Todd Purves, John S. Wiener, and Jonathan C. Routh Hsin-Hsiao S. WangHsin-Hsiao S. Wang More articles by this author , Ruiyang JiangRuiyang Jiang More articles by this author , J. Todd PurvesJ. Todd Purves More articles by this author , John S. WienerJohn S. Wiener More articles by this author , and Jonathan C. RouthJonathan C. Routh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2030AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES With the rising incidence of pediatric nephrolithiasis, the management debate between ureteroscopy (URS) and shockwave lithotripsy (SWL) has become more important. To date, success and complication rates for both have been based on single-institution reports. The aim of this study was to analyze the reported data on the effectiveness of SWL and URS for ureteral stones in children. METHODS We searched Cochrane Controlled Trials Register, clinicaltrials.gov, MEDLINE, and EMBASE for reports in any language. Inclusion criteria were age <18 yrs with ureteral stones who underwent surgical treatment (URS vs SWL) with clearly defined success and complication rate. Manuscripts were then assessed and data abstracted in duplicate, with differences resolved by the senior author. Bias was assessed using standardized instruments. Pooled success and complication rates were estimated. RESULTS We identified a total of 3,356 studies: 99 met inclusion criteria. The overall success rate was 0.80 (95% CI: 0.76-0.83) for SWL and 0.89 (95% CI: 0.86-0.91) for URS. The success rate for URS increased with more distal location: 0.83 (95% CI: 0.73-0.90) for proximal; 0.96 (95% CI: 0.87-0.99) for mid; and 0.94 (95% CI: 0.91-0.97) for distal ureteral stones. By contrast, SWL success decreased more distally: proximal 0.90 (95%CI: 0.83-0.95), mid 0.87 (95% CI: 0.79-0.92), and distal ureter 0.83 (95% CI: 0.72-0.90), respectively. The overall complication rate was not significantly different between the two modalities (SWL 0.04 (95% CI: 0.03-0.06) vs URS 0.06 (95% CI: 0.04-0.09)). Statistically significant heterogeneity was detected in all groups and subgroups of studies (p<0.001). However, little significant publication bias was detected. CONCLUSIONS Compared to SWL, URS was associated with higher overall success rate and similar risk of complications. URS was associated with higher success in treating mid-distal ureteral stones. By contrast, SWL was most successful in treating proximal ureteral stones. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e867 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Hsin-Hsiao S. Wang More articles by this author Ruiyang Jiang More articles by this author J. Todd Purves More articles by this author John S. Wiener More articles by this author Jonathan C. Routh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...