Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK.
Sant 'Andrea Hospital, Sapienza University, Rome, Italy.
J Urol. 2023 Dec;210(6):876-887. doi: 10.1097/JU.0000000000003696. Epub 2023 Sep 5.
We sought to determine which treatment between flexible ureteroscopy and shock wave lithotripsy has a better stone-free rate in pediatric patients (<18 years) with renal or proximal ureteric stones (<2 cm). Subanalysis for all outcomes for randomized controlled trials only.
Using PubMed, Web of Science, and the Cochrane database, we identified studies (randomized clinical trials and prospective comparative nonrandomized studies) published until August 2022 reporting surgical outcomes of pediatrics patients undergoing flexible ureteroscopy and shock wave lithotripsy with renal or proximal ureteric stones <2 cm (PROSPERO ID: CRD42022378790). Only randomized controlled trials were considered for meta-analysis. Stone-free rate, operative time, and complications were analyzed. Analysis was performed in R.
A total of 6 studies identified, of which 3 were randomized clinical trials and 4 had data on renal stones. A total of 669 patients were analyzed. Mean age ranged from 4.4 to 12.4 years. The shock wave lithotripsy group presented a range of stone-free rate between 21 and 90% while the flexible ureteroscopy group presented a range of stone-free rates between 37% and 97%. Meta-analysis of randomized controlled trials only (n=302) demonstrated significantly higher stone-free rate in flexible ureteroscopy vs shock wave lithotripsy (RR = 1.17, 95% CI: 1.04-1.33, = 0.01), operative time (mean difference = +16.4 minutes, 95% CI: 7.3-25.5, < 0.01) and hospital stay (mean difference = +0.25 days, 95% CI: 0.14-0.36, < 0.001). But no difference in fluoroscopy exposure time (mean difference = -21.0 seconds, 95% CI: -42.6 to 0.56, = 0.07), Clavien I-II (RR = 1.23, 95% CI: 0.71-2.12, = 0.45) or Clavien III-V complications (RR = 1.04, 95% CI: 0.32-3.42, = 0.95).
Flexible ureteroscopy has a significantly higher stone-free rate than shock wave lithotripsy, with no difference in complication rate or fluoroscopy exposure time, and significantly higher operative times and hospital stay. However, the current evidence base for this is weak and further randomized trials are needed.
我们旨在确定在患有肾或近端输尿管结石（<2 厘米）的儿科患者（<18 岁）中，输尿管软镜和体外冲击波碎石术之间哪种治疗方法的无结石率更高。仅对随机对照试验进行所有结局的亚组分析。
使用 PubMed、Web of Science 和 Cochrane 数据库，我们确定了截至 2022 年 8 月发表的报告接受肾或近端输尿管结石（<2 厘米）的儿科患者接受输尿管软镜和体外冲击波碎石术的手术结果的研究（随机临床试验和前瞻性非随机对照研究）（PROSPERO ID：CRD42022378790）。仅对随机对照试验进行荟萃分析。分析了无结石率、手术时间和并发症。在 R 中进行分析。
共确定了 6 项研究，其中 3 项为随机临床试验，4 项有肾结石的数据。共分析了 669 名患者。平均年龄范围为 4.4 至 12.4 岁。体外冲击波碎石术组的无结石率为 21%至 90%，而输尿管软镜组的无结石率为 37%至 97%。仅对随机对照试验进行荟萃分析（n=302）表明，输尿管软镜的无结石率显著高于体外冲击波碎石术（RR=1.17，95%CI：1.04-1.33，=0.01），手术时间（平均差异=+16.4 分钟，95%CI：7.3-25.5，<0.01）和住院时间（平均差异=+0.25 天，95%CI：0.14-0.36，<0.001）。但透视曝光时间（平均差异=-21.0 秒，95%CI：-42.6 至 0.56，=0.07）、Clavien I-II（RR=1.23，95%CI：0.71-2.12，=0.45）或 Clavien III-V 并发症（RR=1.04，95%CI：0.32-3.42，=0.95）无差异。
输尿管软镜的无结石率明显高于体外冲击波碎石术，并发症发生率或透视曝光时间无差异，手术时间和住院时间明显更长。然而，目前这方面的证据基础薄弱，需要进一步的随机试验。
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