Department of Urology, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK.
Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore.
World J Urol. 2024 Jul 16;42(1):413. doi: 10.1007/s00345-024-05104-z.
The infundibulo-pelvic angle (IPA) is reportedly a predictor of successful ureteroscopy for lower pole renal stones, however there is uncertainty at which IPA success is likely. We therefore aimed to perform a meta-analysis and determine at which the angle of likely success and failure.
We performed a systematic review and meta-analysis as per Cochrane guidelines in accordance to the PRISMA statement. The review was registered with PROSPERO prior to commencement (ID: CRD42022296732). We included studies reporting on outcomes of ureteroscopy for lower pole stones, with IPA. We excluded patients undergoing alternative treatments for lower pole stones, anatomical abnormalities and studies with < 10 patients. We assessed bias with the Newcastle-Ottawa scale. We performed meta-analysis in R, and summarised the findings as per GRADE.
Overall, there were 13 studies included, with 10 included for meta-analysis. These studies covered n = 1964 patients (71% stone free). Overall, the stone free patients had a significantly less acute mean IPA (52 ± 9), compared to the non-stone free patients (39 ± 7), on meta-analysis (REM MD = -13.0, 95% CI: -18.7 to -7.2, p < 0.001). On examination of forest plots, at IPA < 30 no patients were stone free, whilst > 50 all were stone free. Risk of bias was moderate, and certainty of evidence was 'very low'.
With a very low certainty of evidence, we demonstrate that at an IPA of < 30 no patient is stone free, whilst > 50 all patients (in this review) are stone free. More evidence is therefore needed.
据报道，漏斗骨盆角（IPA）是输尿管镜治疗下极肾结石成功的预测因素，但 IPA 成功的角度尚不确定。因此，我们旨在进行荟萃分析，确定可能成功和失败的角度。
我们按照 Cochrane 指南和 PRISMA 声明进行了系统评价和荟萃分析。该综述在开始前已在 PROSPERO 上注册（ID：CRD42022296732）。我们纳入了报告输尿管镜治疗下极结石 IPA 结果的研究，排除了接受下极结石替代治疗、解剖异常和患者<10 例的研究。我们使用纽卡斯尔-渥太华量表评估偏倚。我们在 R 中进行荟萃分析，并根据 GRADE 总结发现。
共有 13 项研究纳入，其中 10 项进行了荟萃分析。这些研究共涵盖 1964 例患者（71%无结石）。总体而言，无结石患者的平均 IPA 明显较小（52±9），与无结石患者（39±7）相比，差异有统计学意义（随机效应 MD=-13.0，95%CI：-18.7 至-7.2，p<0.001）。在检查森林图时，IPA<30 时没有患者无结石，而 IPA>50 时所有患者均无结石。偏倚风险为中度，证据确定性为“极低”。
基于极低确定性的证据，我们证明 IPA<30 时没有患者无结石，而 IPA>50 时所有患者（本综述中）均无结石。因此，需要更多的证据。
