Extracorporeal shock wave lithotripsy versus retrograde intrarenal surgery for treatment for renal stones 1–2 cm: a meta-analysis

This study is to evaluate the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) versus retrograde intrarenal surgery (RIRS) for the treatment for renal calculi 1–2 cm. PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the Chinese Biomedical Literature Database were researched and hand-searched for relevant congress abstracts and journals about RIRS and ESWL for the treatment for 1- to 2-cm renal stones. The retrieval time ended in September 2014. The related trials met the inclusion criteria were included in the meta-analysis. Two reviewers independently assessed the quality of all included studies, and meta-analysis was performed with RevMan 5.2. Seven literatures were retrieved, including 983 patients. The meta-analysis results showed that, compared to RIRS group, the patients in ESWL group had the following features:(1) the stone-free rate [relative risk (RR) 0.86; 95 % confidence interval (CI) 0.77–0.95, P = 0.005] was significantly different between two groups; (2) The retreatment rate of RIRS group was lower (RR 8.12; 95 % CI 4.77–13.83, P < 0.00); (3) The complications were not significantly different between two groups (Grade I RR 1.06; 95 % CI 0.67–1.69, P = 0.80; Grade II RR 0.75; 95 % CI 0.29–1.91, P = 0.54; Grade III RR 0.86; 95 % CI 0.26–2.86, P = 0.80). Compared to ESWL, our results showed that RIRS provided significantly higher stone-free rate and lower retreatment rate and without increase in the incidence of complications. However, further randomized trials are needed to confirm these findings.