Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1#, Haizhu District, Guangzhou, 510230, China.
Guangzhou Institute of Urology, Guangzhou, China.
World J Urol. 2019 Aug;37(8):1687-1701. doi: 10.1007/s00345-018-2561-7. Epub 2018 Nov 14.
To compare the efficacy and safety of different treatment options for the management of proximal impacted ureteral stones (PIUS).
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.
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.
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.
比较不同治疗方案治疗近端嵌顿输尿管结石（PIUS）的疗效和安全性。
通过 Pubmed、Medline、Embase 和 Cochrane Library 系统检索截至 2018 年 1 月有关 PIUS 不同治疗方法的文献。采用汇总优势比（ORs）、标准均数差（SMDs）或加权均数差及其 95%置信区间（CIs）比较所有纳入治疗方法的疗效和安全性，这些方法均在 PROSPERO 中以 CRD42018092745 编号注册。
共纳入 15 项比较研究，共计 1780 例患者。最终结石清除率（SFR）的荟萃分析结果表明，经皮肾镜碎石术（PCNL）优于输尿管镜碎石术（URL）（OR 10.35；95%CI 5.26-20.35；P<0.00001），腹腔镜输尿管切开术优于 URL（OR 0.11；95%CI 0.05-0.25；P<0.00001），URL 优于体外冲击波碎石术（OR 0.47；95%CI 0.28-0.77；P=0.003）。就并发症而言，PCNL 输血率显著较高（OR 7.47；95%CI 1.3-42.85；P=0.02），输尿管损伤率较低（OR 0.15；95%CI 0.04-0.52；P=0.003），而结石逆行率较低（OR 0.03；95%CI 0.01-0.15；P<0.0001）和治疗费用较高（SMD=2.71；95%CI 0.71-4.70；P=0.008）。
我们的荟萃分析表明，PCNL 可能是 PIUS 的最佳选择，因为它的成功率更高。通过应用微通道 PCNL 可以降低出血等并发症的发生率。
