Alanazi Abdullah Barghash, Alsolami Rawan Marzooq, Albalawi Abdulaziz, Almousa Abdullah, Alhassan Abdullatif, Alotaibi Mutlaq, El-Tholoth Hossam S, Alzahrani Ahmed, Alruwaily Abdulrahman F
Department of Urology, Prince Sultan Medical Military City, Riyadh, Saudi Arabia.
Department of Urology, Ministry of Health, Riyadh, Saudi Arabia.
Urol Ann. 2025 Apr-Jun;17(2):74-83. doi: 10.4103/ua.ua_60_24. Epub 2025 Apr 17.
Numerous therapeutic strategies have been developed as a result of the rise in the prevalence of renal stones. Extracorporeal shock wave lithotripsy (ESWL) retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are currently available treatments for lower-pole renal stones (LPRSs). This systematic review and meta-main analysis's primary objective were to assess the requisite studies that examined the effectiveness of ESWL, RIRS, and PCNL for treating LPRS.
This study adhered to PRISMA guidelines' guiding principles. In two stages, the desired studies were extracted. In the initial screening, we identified 850 related articles from the years 2004 to 2022 using the keywords. Unfortunately, 350 studies were disqualified because they failed to meet our inclusion requirements; the remaining studies underwent additional screening. In the second stage, two authors went through the entire text of the articles and found duplicates and missing data. Ten articles were eventually selected for the research's conclusion.
PCNL and RIRS had higher stone-free rates than ESWL and needed fewer treatment sessions out of the total of 10 clinical trials that were considered to be eligible. While ESWL required more ESWL sessions, operative time and complications seemed to benefit ESWL over PCNL. RIRS looked to be the most efficient technique for treating stones in the lower pole that were up to 1 cm in diameter.
To achieve stone-free status over a brief period of time and with the fewest number of sessions, the management of LPRS should probably be PCNL or RIRS, according to the pooled meta-analysis of the eligible trials in our systematic review. RIRS was more effective than ESWL for stones <10 mm in size. The choice between the two methods (PCNL or RIRS) should be made specifically for each patient depending on their anatomical characteristics, comorbidities, and preferences as deemed appropriate by the attending clinician.
由于肾结石患病率上升，已开发出多种治疗策略。体外冲击波碎石术（ESWL）、逆行肾内手术（RIRS）和经皮肾镜取石术（PCNL）是目前治疗下极肾结石（LPRS）的可用方法。本系统评价和荟萃分析的主要目的是评估检验ESWL、RIRS和PCNL治疗LPRS有效性的相关研究。
本研究遵循PRISMA指南的指导原则。分两个阶段提取所需研究。在初步筛选中，我们使用关键词从2004年至2022年识别出850篇相关文章。遗憾的是，350项研究因不符合纳入标准而被排除；其余研究进行了进一步筛选。在第二阶段，两名作者通读文章全文，发现重复和缺失的数据。最终选择了10篇文章用于研究结论。
在被认为符合条件的10项临床试验中，PCNL和RIRS的结石清除率高于ESWL，且所需治疗次数更少。虽然ESWL需要更多的ESWL治疗次数，但手术时间和并发症方面ESWL似乎优于PCNL。RIRS似乎是治疗直径达1cm的下极结石最有效的技术。
根据我们系统评价中符合条件的试验的汇总荟萃分析，为在短时间内以最少的治疗次数实现结石清除状态，LPRS的治疗可能应选择PCNL或RIRS。对于直径<10mm的结石，RIRS比ESWL更有效。两种方法（PCNL或RIRS）之间的选择应根据每位患者的解剖特征、合并症以及主治医生认为合适的偏好具体做出。
