Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Department of Urology, Inha University School of Medicine, Incheon, Korea.
PLoS One. 2019 Feb 21;14(2):e0211316. doi: 10.1371/journal.pone.0211316. eCollection 2019.
To perform a systematic review and network meta-analysis comparing stone-free rates following retrograde intrarenal surgery (RIRS), extracorporeal shock wave lithotripsy (SWL), and percutaneous nephrolithotomy (PCNL) treatments of renal stones.
Clinical trials comparing RIRS, SWL, and PCNL for treatment of renal stones were identified from electronic databases. Stone-free rates for the procedures were compared by qualitative and quantitative syntheses (meta-analyses). Outcome variables are shown as risk ratios (ORs) with 95% credible intervals (CIs).
A total of 35 studies were included in this network meta-analysis of success and stone-free rates following three different treatments of renal stones. Six studies compared PCNL versus SWL, ten studies compared PCNL versus RIRS, fourteen studies compared RIRS versus SWL, and five studies compared PCNL, SWL, and RIRS. The quality scores within subscales were relatively low-risk. Network meta-analyses indicated that stone-free rates of RIRS (OR 0.38; 95% CI 0.22-0.64) and SWL (OR 0.12; 95% CI 0.067-0.19) were lower than that of PCNL. In addition, stone-free rate of SWL was lower than that of RIRS (OR 0.31; 95% CI 0.20-0.47). Stone free rate of PCNL was also superior to RIRS in subgroup analyses including ≥ 2 cm stone (OR 4.680; 95% CI 2.873-8.106), lower pole stone (OR 1.984; 95% CI 1.043-2.849), and randomized studies (OR 2.219; 95% CI 1.348-4.009). In rank-probability test, PCNL was ranked as No. 1 and SWL was ranked as No. 3.
PCNL showed the highest success and stone-free rate in the surgical treatment of renal stones. In contrast, SWL had the lowest success and stone-free rate.
对逆行性肾内手术（RIRS）、体外冲击波碎石术（SWL）和经皮肾镜取石术（PCNL）治疗肾结石的无结石率进行系统评价和网络荟萃分析。
从电子数据库中确定了比较 RIRS、SWL 和 PCNL 治疗肾结石的临床试验。通过定性和定量综合（荟萃分析）比较手术的无结石率。结果变量以风险比（OR）和 95%可信区间（CI）表示。
共有 35 项研究纳入本项网络荟萃分析，比较了三种不同治疗肾结石的成功率和无结石率。6 项研究比较了 PCNL 与 SWL，10 项研究比较了 PCNL 与 RIRS，14 项研究比较了 RIRS 与 SWL，5 项研究比较了 PCNL、SWL 和 RIRS。子量表内的质量评分风险较低。网络荟萃分析表明，RIRS（OR 0.38；95%CI 0.22-0.64）和 SWL（OR 0.12；95%CI 0.067-0.19）的无结石率低于 PCNL。此外，SWL 的无结石率低于 RIRS（OR 0.31；95%CI 0.20-0.47）。PCNL 在包括≥2cm 结石（OR 4.680；95%CI 2.873-8.106）、下极结石（OR 1.984；95%CI 1.043-2.849）和随机研究（OR 2.219；95%CI 1.348-4.009）的亚组分析中，无结石率也优于 RIRS。在等级概率检验中，PCNL 排名第一，SWL 排名第三。
PCNL 在肾结石的手术治疗中显示出最高的成功率和无结石率。相比之下，SWL 的成功率和无结石率最低。
