Wang Wei, Peng Liao, Di Xingpeng, Gao Xiaoshuai, Wei Xin
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Transl Androl Urol. 2021 May;10(5):2122-2132. doi: 10.21037/tau-21-39.
To determine whether previous unsuccessful shockwave lithotripsy (SWL) influence the outcomes of ureteroscopy (URS).
An exhaustive search of PubMed, EMBASE, Web of Science and Cochrane Library were conducted to find eligible studies before October 2020. Result variables consisting stone-free rate (SFR), operation time and postoperative modified Clavien grade I-IV complications were pooled utilizing RevMan 5.3.
Seven studies with 2413 individuals were included. Pooled results revealed that the salvage URS after failed SWL was similar to URS performed primarily regarding SFR [odds ratio (OR) =0.84, P=0.15] and operation time [weighted mean difference (WMD) =6.79, P=0.19]. Additionally, no statistically significant differences concerning fever (OR: 1.36; P=0.32), hematuria (OR: 0.81; P=0.75), urinary tract infection (OR: 1.57; P=0.28), renal colic (OR: 1.94; P=0.50), ureteral perforation (OR: 1.44; P=0.46), ureteral avulsion (OR: 1.21; P=0.83), stone migration (OR: 0.92; P=0.86) and sepsis (OR: 0.46; P=0.38) were observed between salvage URS and primary URS group.
The success rates and complications of URS were not impacted by previous unsuccessful SWL. The salvage URS is equally effective and safe to primary URS.
确定既往冲击波碎石术（SWL）失败是否会影响输尿管镜检查（URS）的结果。
在2020年10月之前，对PubMed、EMBASE、科学网和考克兰图书馆进行了详尽检索，以查找符合条件的研究。利用RevMan 5.3汇总了包括无石率（SFR）、手术时间和术后改良Clavien I-IV级并发症在内的结果变量。
纳入了7项研究，共2413例个体。汇总结果显示，SWL失败后补救性URS与初次进行的URS在SFR方面相似[比值比（OR）=0.84，P=0.15]，在手术时间方面也相似[加权平均差（WMD）=6.79，P=0.19]。此外，在补救性URS组和初次URS组之间，在发热（OR：1.36；P=0.32）、血尿（OR：0.81；P=0.75）、尿路感染（OR：1.57；P=0.28）、肾绞痛（OR：1.94；P=0.50）、输尿管穿孔（OR：1.44；P=0.46）、输尿管撕脱（OR：1.21；P=0.83）、结石迁移（OR：0.92；P=0.86）和脓毒症（OR：0.46；P=0.38）方面未观察到统计学上的显著差异。
既往SWL失败并未影响URS的成功率和并发症。补救性URS与初次URS同样有效且安全。
