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Erschienen in: World Journal of Urology 8/2019

14.11.2018 | Original Article

Systematic review and cumulative analysis of the managements for proximal impacted ureteral stones

verfasst von: Tuo Deng, Yiwen Chen, Bing Liu, M. Pilar Laguna, Jean J. M. C. H. de la Rosette, Xiaolu Duan, Wenqi Wu, Guohua Zeng

Erschienen in: World Journal of Urology | Ausgabe 8/2019

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Abstract

Purpose

To compare the efficacy and safety of different treatment options for the management of proximal impacted ureteral stones (PIUS).

Methods

A systematic literature search using Pubmed, Medline, Embase and Cochrane Library was conducted to obtain studies concerning different managements for PIUS up to Jan 2018. Summary odds ratios (ORs), standard mean differences (SMDs) or weighted mean differences with their 95% confidence intervals (CIs) were calculated to compare the efficacy and safety of all included treatment methods, registered in PROSPERO under number CRD42018092745.

Results

A total of 15 comparative studies with 1780 patients were included. Meta-analyses of final stone-free rate (SFR) favored percutaneous nephrolithotomy (PCNL) over ureteroscopic lithotripsy (URL) (OR 10.35; 95% CI 5.26–20.35; P < 0.00001), laparoscopic ureterolithotomy over URL (OR 0.11; 95% CI 0.05–0.25; P < 0.00001) and URL over extracorporeal shockwave lithotripsy (OR 0.47; 95% CI 0.28–0.77; P = 0.003). As to complications, PCNL had a significantly higher blood transfusion rate (OR 7.47; 95% CI 1.3–42.85; P = 0.02) and a lower ureteral injury rate (OR 0.15; 95% CI 0.04–0.52; P = 0.003) compared with URL. It also shared a significantly lower stone-retropulsion rate (OR 0.03; 95% CI 0.01–0.15; P < 0.0001) and higher treatment costs (SMD = 2.71; 95% CI 0.71–4.70; P = 0.008) than URL.

Conclusions

Our meta-analysis suggested that PCNL might be the best option for PIUS owing to its higher successful rate. Complications such as hemorrhage could be decreased by the application on mini-PCNL.
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Metadaten
Titel
Systematic review and cumulative analysis of the managements for proximal impacted ureteral stones
verfasst von
Tuo Deng
Yiwen Chen
Bing Liu
M. Pilar Laguna
Jean J. M. C. H. de la Rosette
Xiaolu Duan
Wenqi Wu
Guohua Zeng
Publikationsdatum
14.11.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
World Journal of Urology / Ausgabe 8/2019
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-018-2561-7

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