Retrograde Intrarenal Surgery Versus Percutaneous Nephrolithotomy Versus Extracorporeal Shockwave Lithotripsy for Treatment of Lower Pole Renal Stones: A Meta-Analysis and Systematic Review. 2015

Wei Zhang, and Tie Zhou, and Tengyun Wu, and Xiaofeng Gao, and Yonghan Peng, and Chuanliang Xu, and Qi Chen, and Ruixiang Song, and Yinghao Sun
1 Department of Urology, Changhai Hospital, Second Military Medical University , Shanghai, China .

OBJECTIVE The optimal treatment of patients with lower pole renal stones continues to be a dilemma for urologists. Retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and extracorporeal shockwave lithotripsy (SWL) all constitute viable therapeutic options in selected patients. The aim of this study was to assess the efficacy and safety of RIRS, PCNL, and SWL in management of lower pole renal stones. METHODS A literature search was performed in July 2014 using PubMed, Embase, and Web of Science databases. Literature reviewed included meta-analysis and randomized and nonrandomized controlled studies to identify relevant studies for the meta-analysis. RESULTS Six randomized and eight nonrandomized studies were identified for analysis. PCNL provided a significantly higher stone-free rate (SFR) compared with RIRS and SWL. Furthermore, no statistical significant difference was found when PCNL was compared with RIRS and SWL for complication rate. Compared with the other two treatments, RIRS had a longer operative time and PCNL had a longer hospital stay. SWL was associated with significantly higher re-treatment rate compared with RIRS and PCNL, whereas there were no significant differences in auxiliary procedure rates among the three treatment techniques. CONCLUSIONS RIRS offers a relative higher SFR while it has a longer operative time. PCNL is associated with the highest SFR at the expense of the longest hospital stay. SWL is performed as an outpatient procedure with a relative shorter operative time; however, it has lower a SFR and higher re-treatment rate. The categories of complications vary while the overall complication rates are comparable among the three treatment techniques.

UI MeSH Term Description Entries
D007669 Kidney Calculi Stones in the KIDNEY, usually formed in the urine-collecting area of the kidney (KIDNEY PELVIS). Their sizes vary and most contains CALCIUM OXALATE. Kidney Stones,Renal Calculi,Nephrolith,Renal Calculus,Calculi, Kidney,Calculi, Renal,Calculus, Kidney,Calculus, Renal,Kidney Calculus,Kidney Stone,Stone, Kidney,Stones, Kidney
D008096 Lithotripsy The destruction of a calculus of the kidney, ureter, bladder, or gallbladder by physical forces, including crushing with a lithotriptor through a catheter. Focused percutaneous ultrasound and focused hydraulic shock waves may be used without surgery. Lithotripsy does not include the dissolving of stones by acids or litholysis. Lithotripsy by laser is LITHOTRIPSY, LASER. ESWL (Extracorporeal Shockwave Lithotripsy),Electrohydraulic Shockwave Lithotripsy,Extracorporeal Shockwave Lithotripsy,Litholapaxy,Noninvasive Litholapaxy,Percutaneous Ultrasonic Lithotripsy,Ultrasonic Lithotripsy,ESWLs (Extracorporeal Shockwave Lithotripsy),Electrohydraulic Shockwave Lithotripsies,Extracorporeal Shockwave Lithotripsies,Litholapaxies,Litholapaxies, Noninvasive,Litholapaxy, Noninvasive,Lithotripsies,Lithotripsies, Electrohydraulic Shockwave,Lithotripsies, Extracorporeal Shockwave,Lithotripsies, Percutaneous Ultrasonic,Lithotripsies, Ultrasonic,Lithotripsy, Electrohydraulic Shockwave,Lithotripsy, Extracorporeal Shockwave,Lithotripsy, Percutaneous Ultrasonic,Lithotripsy, Ultrasonic,Noninvasive Litholapaxies,Percutaneous Ultrasonic Lithotripsies,Shockwave Lithotripsies, Electrohydraulic,Shockwave Lithotripsies, Extracorporeal,Shockwave Lithotripsy, Electrohydraulic,Shockwave Lithotripsy, Extracorporeal,Ultrasonic Lithotripsies,Ultrasonic Lithotripsies, Percutaneous,Ultrasonic Lithotripsy, Percutaneous
D009403 Nephrostomy, Percutaneous The insertion of a catheter through the skin and body wall into the kidney pelvis, mainly to provide urine drainage where the ureter is not functional. It is used also to remove or dissolve renal calculi and to diagnose ureteral obstruction. Percutaneous Nephrostomy,Nephrostomies, Percutaneous,Percutaneous Nephrostomies
D002986 Clinical Trials as Topic Works about pre-planned studies of the safety, efficacy, or optimum dosage schedule (if appropriate) of one or more diagnostic, therapeutic, or prophylactic drugs, devices, or techniques selected according to predetermined criteria of eligibility and observed for predefined evidence of favorable and unfavorable effects. This concept includes clinical trials conducted both in the U.S. and in other countries. Clinical Trial as Topic
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012449 Safety Freedom from exposure to danger and protection from the occurrence or risk of injury or loss. It suggests optimal precautions in the workplace, on the street, in the home, etc., and includes personal safety as well as the safety of property. Safeties
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D061646 Operative Time The duration of a surgical procedure in hours and minutes. Length of Operative Time,Surgical Time,Time Length of Surgery,Operative Time Length,Operative Time Lengths,Operative Times,Surgery Time Length,Surgery Time Lengths,Surgical Times,Time Length, Operative,Time Lengths, Operative,Time, Operative,Time, Surgical,Times, Operative,Times, Surgical
D018579 Patient Selection Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. Patient Recruitment,Research Subject Recruitment,Selection Criteria,Research Subject Selection,Selection for Treatment,Selection of Research Volunteers,Selection of Subjects,Criteria, Selection,Recruitment, Patient,Recruitment, Research Subject,Recruitments, Research Subject,Research Subject Recruitments,Research Subject Selections,Research Volunteers Selection,Research Volunteers Selections,Selection for Treatments,Selection, Patient,Selection, Research Subject,Selections, Research Subject,Subject Recruitment, Research,Subject Recruitments, Research,Subject Selection, Research,Subject Selections, Research,Subjects Selection,Subjects Selections,Treatment, Selection for,Treatments, Selection for,Volunteers Selection, Research
D019233 Retreatment The therapy of the same disease in a patient, with the same agent or procedure repeated after initial treatment, or with an additional or alternate measure or follow-up. It does not include therapy which requires more than one administration of a therapeutic agent or regimen. Retreatment is often used with reference to a different modality when the original one was inadequate, harmful, or unsuccessful. Retreatments

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