The Efficacy of Flexible Ureterorenoscopy Compared with Extracorporeal Shock Wave Lithotripsy for <20 mm Renal Stone: A Systematic Review and Meta-Analysis

Abstract

ABSTRACT Introduction: Renal stone is a common urological problem that has increased over the years. Extracorporeal shock wave lithotripsy (ESWL) is a noninvasive treatment for patients with <20 mm renal stones, but it also has a lower stone-free rate (SFR) and a higher re-treatment rate (RR) compared to other modalities. On the other hand, flexible ureterorenoscopy (F-URS) can be used to manage larger renal stones and is associated with higher SFR. Thus, we created this study to assess the efficacy and safety of F-URS versus ESWL for patients with <20 mm renal stones. Methods: This systematic review and meta-analysis study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and used PICO analysis to systematically search the included studies from several databases, such as PubMed and ScienceDirect. Sixteen relevant studies were included for qualitative and quantitative analysis. Cochrane risk-of-bias tool for randomized trials (RoB) 2.0 was used as bias analysis for RCT studies and the Newcastle-Ottawa Scale for observational studies. Results: A total of 2487 patients were included in this study. The SFR was significantly higher in the F-URS group (P < 0.00001), while the auxiliary procedure was significantly higher in the ESWL group (P < 0.00001). However, neither significant difference was observed in the mean operative time, RR Clavien–Dindo classification, and complication rate-based symptom outcomes in both the groups. Conclusion: F-URS and ESWL are safe and effective in treating <20 mm renal stones. In terms of SFR, F-URS is superior compared to ESWL. However, a lower complication rate was observed in ESWL.