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Mazzucchi E, Berto FC, Denstedt J, Danilovic A, Batagello CA, Torricelli FC, Vicentini FC, Marchini GS, Srougi M, Nahas WC. Treatment of renal lower pole stones: an update. Int Braz J Urol 2022; 48:165-174. [PMID: 33861537 PMCID: PMC8691227 DOI: 10.1590/s1677-5538.ibju.2020.1023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/19/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Eduardo Mazzucchi
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - Fernanda C.G. Berto
- Western University OntarioDivision of UrologyCanadaDivision of Urology, Western University Ontario, Canada
| | - John Denstedt
- Western University OntarioDivision of UrologyCanadaDivision of Urology, Western University Ontario, Canada
| | - Alexandre Danilovic
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - Carlos Alfredo Batagello
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - Fabio C.M. Torricelli
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - Fabio C. Vicentini
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - Giovanni S. Marchini
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - Miguel Srougi
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - William C. Nahas
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
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Walters A, Massella V, Pietropaolo A, Seoane LM, Somani B. Decision-Making, Preference, and Treatment Choice for Asymptomatic Renal Stones-Balancing Benefit and Risk of Observation and Surgical Intervention: A Real-World Survey Using Social Media Platform. J Endourol 2021; 36:522-527. [PMID: 34806905 DOI: 10.1089/end.2021.0677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction: The burden of kidney stone disease has risen, and several treatment options now exist. We wanted to evaluate the preference and treatment choices based on the information provided for management of hypothetical 8 and 15 mm renal stone, and factors that influenced their decision. Materials and Methods: An online questionnaire to investigate trends in decision-making for two hypothesized scenarios of asymptomatic kidney stones (8 and 15 mm) was formatted online in Microsoft Forms and posted on social media (Facebook) in Europe. The ethical approval was obtained from the University Ethics Committee, and data were collected from general public between September and November 2020. Results: A total of 476 participants of different age and background answered the survey with a male:female ratio of 1:2.7. The age groups were categorized as 18-25 years (n = 149), 26-49 years (n = 192), and 50+ years (n = 135). In the 8 mm scenario, 107 of the 476 participants (22.5%) chose observation, 249 (52.3%) chose extracorporeal shockwave lithotripsy (SWL) and 120 (25.2%) opted for ureteroscopy (URS). In the 15 mm scenario, 194 participants chose SWL treatment (40.8%), 216 (45.4%) URS, and 66 (13.9%) preferred percutaneous nephrolithotomy. The influencing factors were success rate, complication risk and invasiveness of the procedure. On comparison to 8 mm stone, while stent avoidance and activity limitation were considered less important with 15 mm stone (p < 0.001), complication rates were considered more important (p < 0.001). Conclusion: More than one treatment choice for kidney stones often exists and clinicians must take patient choice into account via an informed decision-making process. While some might accept a higher risk of invasiveness and complications for higher stone-free rate, others might have a more conservative approach to this. It is about time that urologists take patient priorities and concerns into account and perhaps use Patient Reported Outcome Measures in addition to clinical outcomes when comparing treatment success.
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Affiliation(s)
- Alexander Walters
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Virginia Massella
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Lucia Mosquera Seoane
- Department of Urology, Complexo Hospitalario Universitario de Ourense, Orense, Spain
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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Grüne B, Kowalewksi KF, Waldbillig F, von Hardenberg J, Rassweiler-Seyfried MC, Kriegmair MC, Herrmann J. The Comprehensive Complication Index (CCI) for improved reporting of complications in endourological stone treatment. Urolithiasis 2021; 49:269-279. [PMID: 33388823 DOI: 10.1007/s00240-020-01234-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/21/2020] [Indexed: 12/23/2022]
Abstract
The Clavien-Dindo Classification (CDC) lacks a combined score of multiple complications in one patient. The comprehensive complication index (CCI) circumvents this problem making it a valuable instrument to optimize quality control. We aimed to introduce and validate CCI in the treatment of urolithiasis. 60 day postoperative complications of 327 consecutive patients undergoing percutaneous nephrolitholapaxy (PNL) and ureterorenoscopy (URS) between 2017 and 2019 were retrospectively assessed and graded according to CDC. CCI was calculated for each patient. Overall morbidity scores of CCI and CDC were compared. Correlation analyses between the two scores and length of hospital stay (LOS) were performed. A multivariate analysis was performed to identify predictive factors for complications. Sample size calculation for an imaginary clinical trial was compared between CCI and CDC. A significant difference in overall morbidity between CCI and CDC was revealed for PNL (p < 0.001) and URS (p = 0.001). There was no statistically significant difference in comparing correlations between cumulative CCI and LOS versus non-cumulative CDC and LOS for both cohorts. Operating time > 90 min, maximum stone size, positive preoperative urine culture and PNL type (p < 0.001) were predictive factors for postoperative complications in PNL, while urine culture (p = 0.02) was for URS. Sample size calculation based on CCI resulted in a significant reduction of required patients for PNL (- 48%) and URS (- 84%) compared to CDC. CCI could successfully be validated in endourological stone treatment with the advantage of assessing complications in their entirety compared to CDC. CCI can significantly reduce the required sample size in future clinical trials.
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Affiliation(s)
- Britta Grüne
- Department of Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Karl-Friedrich Kowalewksi
- Department of Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Frank Waldbillig
- Department of Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jost von Hardenberg
- Department of Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Marie-Claire Rassweiler-Seyfried
- Department of Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jonas Herrmann
- Department of Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Kim CH, Chung DY, Rha KH, Lee JY, Lee SH. Effectiveness of Percutaneous Nephrolithotomy, Retrograde Intrarenal Surgery, and Extracorporeal Shock Wave Lithotripsy for Treatment of Renal Stones: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2020; 57:26. [PMID: 33396839 PMCID: PMC7823824 DOI: 10.3390/medicina57010026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/21/2020] [Accepted: 12/26/2020] [Indexed: 12/16/2022]
Abstract
Background and objectives: To perform a updated systematic review and meta-analysis comparing effectiveness of percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stones (RS). Materials and Methods: A total of 37 studies were included in this systematic review and meta-analysis about effectiveness to treat RS. Endpoints were stone-free rates (SFR), incidence of auxiliary procedure, retreatment, and complications. We also conducted a sub-analysis of ≥2 cm stones. Results: First, PCNL had the highest SFR than others regardless of stone sizes and RIRS showed a higher SFR than ESWL in <2 cm stones. Second, auxiliary procedures were higher in ESWL than others, and it did not differ between PCNL and RIRS. Finally, in <2 cm stones, the retreatment rate of ESWL was higher than others. RIRS required significantly more retreatment procedures than PCNL in ≥2 cm stones. Complication was higher in PCNL than others, but there was no statistically significant difference in complications between RIRS and PCNL in ≥2 cm stones. For ≥2 cm stones, PCNL had the highest SFR, and auxiliary procedures and retreatment rates were significantly lower than others. Conclusions: We suggest that PCNL is a safe and effective treatment, especially for large RS.
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Affiliation(s)
- Chan Hee Kim
- Department of Nursing Science, College of Nursing, Gachon University, Incheon 22212, Korea;
| | - Doo Yong Chung
- Department of Urology, Inha University School of Medicine, Incheon 22212, Korea;
| | - Koon Ho Rha
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea;
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul 03722, Korea
| | - Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon 22212, Korea;
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Qiang YC, Guo YG, Wang YQ. The effectiveness and safety of extracorporeal shock wave lithotripsy for the management of kidney stones: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e19915. [PMID: 32384436 PMCID: PMC7220461 DOI: 10.1097/md.0000000000019915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study will assess the effectiveness and safety of extracorporeal shock wave lithotripsy (ESWL) for patients with kidney stones (KS). METHODS A comprehensive and systematic literature records search for studies will be conducted in MEDLINE, EMBASE, Cochrane Library, WANGFANG, VIP, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All these databases will be searched from inception to the present without language limitation. Cochrane risk of bias tool will be used to assess the methodological quality for all included studies. Statistical analysis is performed using RevMan 5.3 software. RESULTS This study will provide synthesis of current evidence of ESWL for patients with KS through assessing primary outcomes of overall stone-free rate, and secondary outcomes of mean stone size (mm), pain intensity, urinary biochemical variables, mean hospital stay (day), quality of life, and adverse events. CONCLUSION This study will provide recommendations for the effectiveness and safety of ESWL for patients with KS, which may help to guide clinician. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019157243.
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Affiliation(s)
- Yong-chun Qiang
- Department of Urology, Xianyang Hospital of Yan’an University
| | - Yu-ge Guo
- Department of Obstetrics and Gynecology
| | - Yun-qi Wang
- Department of Urology, Yangling Demonstration District Hospital, Xianyang, China
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Tsai SH, Chung HJ, Tseng PT, Wu YC, Tu YK, Hsu CW, Lei WT. Comparison of the efficacy and safety of shockwave lithotripsy, retrograde intrarenal surgery, percutaneous nephrolithotomy, and minimally invasive percutaneous nephrolithotomy for lower-pole renal stones: A systematic review and network meta-analysis. Medicine (Baltimore) 2020; 99:e19403. [PMID: 32150088 PMCID: PMC7478758 DOI: 10.1097/md.0000000000019403] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and minimally invasive PCNL are currently therapeutic options for lower-pole renal stones (LPS). However, the optimal treatment for LPS remains unclear. A comprehensive evaluation of the efficacy and safety of each intervention is needed to inform clinical decision-making. This study aimed at assessing the efficacy and safety of different interventions for LPS. METHODS PubMed, Embase, ScienceDirect, ClinicalKey, Cochrane Library, ProQuest, Web of Science, and ClinicalTrials.gov were searched from inception to December 6th 2018. Only randomized controlled trials (RCTs) including the patients treated for LPS were included. The frequentist models of network meta-analysis were used to compare the effect sizes. The primary outcome was stone free rate, and the secondary outcomes were overall complication rate, major complication rate, retreatment rate, and auxiliary procedure rate. RESULTS This study included 13 RCTs comprising 1832 participants undergoing 6 different interventions, including RIRS, PCNL, Mini-PCNL, Micro-PCNL, SWL, and conservative observation. PCNL had the best stone free rate (odds ratio [OR] = 3.45, 95% confidence interval [CI] = 1.30-9.12), followed by Mini-PCNL (OR = 2.90, 95% CI = 1.13-7.46). Meta-regression did not find any association of the treatment effect with age, sex, and stone size. Although PCNL tended to exhibit a higher complication rate, the difference of complication rate among various interventions did not achieve a statistical significance. SWL was the less effective and associated with higher retreatment rate compared with PCNL, Mini-PNCL, and RIRS. CONCLUSIONS PCNL was associated with the best stone free rate for LPS regardless of age, sex, and stone size. Each treatment achieved a similar complication rate compared with the others. Future large-scale RCTs are warranted to identify the most beneficial management for renal stones at a more complicated location.
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Affiliation(s)
- Sheng-Han Tsai
- Department of Urology, Cheng Hsin General Hospital
- School of Medicine, National Yang-Ming University
| | - Hsiao-Jen Chung
- School of Medicine, National Yang-Ming University
- Department of Urology, Taipei Veterans General Hospital
| | | | - Yi-Cheng Wu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan
| | - Yu-Kang Tu
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Wei-Te Lei
- Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
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Chung DY, Kang DH, Cho KS, Jeong WS, Jung HD, Kwon JK, Lee SH, Lee JY. Comparison of stone-free rates following shock wave lithotripsy, percutaneous nephrolithotomy, and retrograde intrarenal surgery for treatment of renal stones: A systematic review and network meta-analysis. PLoS One 2019; 14:e0211316. [PMID: 30789937 PMCID: PMC6383992 DOI: 10.1371/journal.pone.0211316] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/13/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES 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. MATERIALS AND METHODS 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). RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Doo Yong Chung
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hyuk Kang
- Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Jeong
- Department of Urology, Kwangju Christian Hospital, Gwangju, Korea
| | - Hae Do Jung
- Department of Urology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
| | - Jong Kyou Kwon
- Department of Urology, Severance Check-Up, Yonsei University Health System, Seoul, Korea
| | - Seon Heui Lee
- Department of Nursing Science, Gachon University College of Nursing, Incheon, Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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External physical vibration lithecbole facilitating the expulsion of upper ureteric stones 1.0-2.0 cm after extracorporeal shock wave lithotripsy: a prospective randomized trial. Urolithiasis 2018; 48:71-77. [PMID: 30488093 PMCID: PMC6989669 DOI: 10.1007/s00240-018-1100-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 11/26/2018] [Indexed: 11/17/2022]
Abstract
To observe the efficacy and safety of External Physical Vibration Lithecbole (EPVL) in patients with upper ureteric stones 1.0–2.0 cm after extracorporeal shock wave lithotripsy (ESWL). A total of 271 patients with upper ureteric stones 1.0–2.0 cm were prospectively randomized into two groups. One hundred and twenty-seven cases in the treatment group accepted EPVL therapy and 144 cases as control after ESWL. The stone expulsion status and stone-free rates (SFRs) between two groups were compared at the 1st, 2nd and 4th weekends by imaging examinations. All of 271 patients were randomly assigned to two groups, of which 127 patients were included in the treatment group and 144 in the control group. EPVL was successful in assisting the discharge of stone fragments. The rate of stone expulsion at day 1 in the treatment group was significantly higher than in the control group (79.5% vs. 64.6%, P = 0.006). The SFRs of the 1st weekend (76.3% vs. 61.8%, P = 0.010), the 2nd weekend (88.2% vs. 77.1%, P = 0.017) and the 4th weekend (92.1% vs. 84.0%, P = 0.042) in the treatment group were all significantly higher than that in the control group. However, no statistical significance was found in complications between the two groups (P > 0.05). Furthermore, in the treatment group the patients were treated a mean 4.3 sessions of EPVL. EPVL and ESWL are ideal complementary partners in the treatment of upper ureteric stones 1.0–2.0 cm, satisfying both high SFR and low complication. This method is safe and reproducible in clinical practice, and it also needs large-scale multicenter prospective studies further to prove the above conclusions.
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Bahílo Mateu P, Budía Alba A, Liatsikos E, Trassierra Villa M, López-Acón JD, de Guzmán Ordaz D, Boronat Tormo F. Is extracorporeal shock wave lithotripsy a current treatment for urolithiasis? A systematic review. Actas Urol Esp 2017; 41:426-434. [PMID: 28336203 DOI: 10.1016/j.acuro.2017.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Technological advances have prompted a change in the management of urolithiasis. Endourological techniques are gaining importance because they are highly effective treatments. The aim of this study was to answer the question of whether extracorporeal shock wave lithotripsy (ESWL) is still a competitive alternative compared with other therapeutic modalities. ACQUISITION OF EVIDENCE We conducted a literature search of articles published in the past 5 years. We identified 12 randomized and comparative studies and assessed the methodology and results of the study variables. We performed a narrative synthesis of the included studies. To summarise the variables, we used the mean and standard deviation for continuous variables and absolute numbers and percentages for the qualitative variables. ANALYSIS OF THE EVIDENCE Of the studies reviewed, 7 evaluated the various treatments for nephrolithiasis and 5 evaluated the treatments for ureteral lithiasis. At the renal level, a stone-free rate of 33.33-91.5% at 3 months was reached with ESWL, while a rate of 90.4-100% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. At the ureteral level, a stone-free rate of 73.5-82.2% at 3 months was reached with ESWL, while a rate of 79-94.1% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. CONCLUSION There is a lack of homogeneity among the published studies. ESWL is a minimally invasive treatment that with an appropriate technique and patient selection achieves high effectiveness, thus maintaining an important role at this time.
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Affiliation(s)
- P Bahílo Mateu
- Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - A Budía Alba
- Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | - M Trassierra Villa
- Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - J D López-Acón
- Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - D de Guzmán Ordaz
- Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - F Boronat Tormo
- Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España
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Hevia M, García Á, Ancizu F, Merino I, Velis J, Tienza A, Algarra R, Doménech P, Diez-Caballero F, Rosell D, Pascual J, Robles J. Predicting the effectiveness of extracorporeal shock wave lithotripsy on urinary tract stones. Risk groups for accurate retreatment. Actas Urol Esp 2017; 41:451-457. [PMID: 28268076 DOI: 10.1016/j.acuro.2016.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive, safe and effective treatment for urinary tract lithiasis. Its effectiveness varies depending on the location and size of the stones as well as other factors; several sessions are occasionally required. The objective is to attempt to predict its success or failure, when the influential variables are known beforehand. MATERIAL AND METHODS We analysed 211 patients who had had previous CT scans and were treated with ESWL between 2010 and 2014. The influential variables in requiring retreatment were studied using binary logistic regression models (univariate and multivariate analysis): maximum density, maximum diameter, area, location, disintegration and distance from the adipose panniculus. With the influential variables, a risk model was designed by assessing all possible combinations with logistic regression (version 20.0 IBM SPSS). RESULTS The independent influential variables on the need for retreatment are: maximum density >864HU, maximum diameter >7.5mm and pyelocaliceal location. Using these variables, the best model includes 3risk groups with a probability of requiring significantly different retreatment: group 1-low risk (0 variables) with 20.2%; group 2-intermediate risk (1-2 variables) with 49.2%; and group 3-high risk (3 variables) with 62.5%. CONCLUSIONS The density, maximum diameter and pyelocaliceal location of the stones are determinant factors in terms of the effectiveness of treatment with ESWL. Using these variables, which can be obtained in advance of deciding on a treatment, the designed risk model provides a precise approach in choosing the most appropriate treatment for each particular case.
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Chan LH, Good DW, Laing K, Phipps S, Thomas BG, Keanie JY, Tolley DA, Cutress ML. Primary SWL Is an Efficient and Cost-Effective Treatment for Lower Pole Renal Stones Between 10 and 20 mm in Size: A Large Single Center Study. J Endourol 2017; 31:510-516. [DOI: 10.1089/end.2016.0825] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Luke H. Chan
- Department of Urology, The Scottish Lithotriptor Centre, Western General Hospital, NHS Lothian, Edinburgh, Scotland
| | - Daniel W. Good
- Department of Urology, The Scottish Lithotriptor Centre, Western General Hospital, NHS Lothian, Edinburgh, Scotland
| | - Karina Laing
- Department of Urology, The Scottish Lithotriptor Centre, Western General Hospital, NHS Lothian, Edinburgh, Scotland
| | - Simon Phipps
- Department of Urology, The Scottish Lithotriptor Centre, Western General Hospital, NHS Lothian, Edinburgh, Scotland
| | - Ben G. Thomas
- Department of Urology, The Scottish Lithotriptor Centre, Western General Hospital, NHS Lothian, Edinburgh, Scotland
| | - Julian Y. Keanie
- Department of Urology, The Scottish Lithotriptor Centre, Western General Hospital, NHS Lothian, Edinburgh, Scotland
| | - David A. Tolley
- Department of Urology, The Scottish Lithotriptor Centre, Western General Hospital, NHS Lothian, Edinburgh, Scotland
| | - Mark L. Cutress
- Department of Urology, The Scottish Lithotriptor Centre, Western General Hospital, NHS Lothian, Edinburgh, Scotland
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Pieras E, Tubau V, Brugarolas X, Ferrutxe J, Pizá P. Comparative analysis between percutaneous nephrolithotomy and flexible ureteroscopy in kidney stones of 2-3cm. Actas Urol Esp 2017; 41:194-199. [PMID: 27793365 DOI: 10.1016/j.acuro.2016.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 08/07/2016] [Accepted: 08/08/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION To compare percutaneous nephrolithotomy and flexible ureterorenoscopy for treating kidney stones between 2 and 3cm. MATERIAL AND METHODS A prospective, comparative, nonrandomised study was conducted with 108 patients with kidney stones between 2 and 3cm. Fifty-four patients underwent percutaneous nephrolithotomy and 54 underwent flexible ureteroscopy. We compared the following variables: lithiasis-free rate (%), surgical time, the need for an auxiliary process, postoperative complications, hospital stay, readmission rates and recovery time. RESULTS There were no differences in the lithiasis-free rate between the 2 surgical techniques (76% for ureteroscopy vs. 87% for nephrolithotomy; P=.1) or in the complications (29% for nephrolithotomy vs. 27% for ureteroscopy; P=.4). A larger number of auxiliary process were needed for the ureteroscopy group (20%) than for the nephrolithotomy group (7%) (P=.04). The surgical time was longer for the nephrolithotomy group (121±52min) than for the ureteroscopy group (93±42min) (P=.004). The ureteroscopy group had shorter hospital stays (2.1±1.6 vs. 3.9±1.9 days; P=.002), shorter convalescence (8.1±4.9 vs. 13.3±4.2 days; P=.005) and higher readmission rates (7.4% vs. 0%, P=.05) than the nephrolithotomy group. CONCLUSIONS Nephrolithotomy and ureteroscopy have similar efficacy for treating kidney stones measuring 2-3cm, with no differences in complications. Ureteroscopy results in shorter hospital stays, quicker recoveries but more readmissions and a greater need for auxiliary procedures.
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Simal I, Parente A, Burgos L, Ortiz R, Martínez AB, Rojo R, Pérez-Egido L, Angulo JM. Therapeutic possibilities for urolithiasis in childhood. Actas Urol Esp 2016; 40:577-584. [PMID: 27289139 DOI: 10.1016/j.acuro.2016.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 03/18/2016] [Accepted: 03/28/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We present our case studies on paediatric urolithiasis, the techniques employed in its treatment and its results. MATERIAL AND METHODS A retrospective study of paediatric urolithiasis of the upper urinary tract (UUT) treated at our centre between 2003 and 2014. We recorded demographic, clinical, diagnostic and therapeutic data and the complications. The therapeutic plan was recorded as isolated (extracorporeal lithotripsy, ureterorenoscopy, nephrolithotomy or surgery) or combined therapy. RESULTS We examined 41 renal/urethral units in 32 patients. The median age was 5 years (range, 11 months-14 years). The mean size was 12.9cm (±7.3mm). The locations were as follows: 23 (56%) in the renal pelvis (staghorn in 15 cases), 10 (24) in lower calyx and 8 (20%) in the urethra. We performed 80 procedures, with no differences in the age groups, which resulted in 12 complications (15%) but no septic condition secondary to lithotripsy. Stone removal from the urethra had a 100% success rate with the ureterorenoscopy. The overall cure rate was 90%. CONCLUSION The paediatric urolithiasis approach offers multiple alternatives. It is therefore important to tailor the procedure according to the size, location and composition of the stone. In our centre, the use of paediatric extracorporeal shock wave lithotripsy is safer. Ureterorenoscopy, semirigid or flexible, provides excellent results in ureters. Percutaneous nephrolithotomy with minimal access can be performed on small children and nursing infants.
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Affiliation(s)
- I Simal
- Servicio de Cirugía Pediátrica, Sección de Urología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - A Parente
- Servicio de Cirugía Pediátrica, Sección de Urología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - L Burgos
- Servicio de Cirugía Pediátrica, Sección de Urología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - R Ortiz
- Servicio de Cirugía Pediátrica, Sección de Urología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A B Martínez
- Servicio de Nefrología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - R Rojo
- Servicio de Cirugía Pediátrica, Sección de Urología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - L Pérez-Egido
- Servicio de Cirugía Pediátrica, Sección de Urología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J M Angulo
- Servicio de Cirugía Pediátrica, Sección de Urología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, España
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Mi Y, Ren K, Pan H, Zhu L, Wu S, You X, Shao H, Dai F, Peng T, Qin F, Wang J, Huang Y. Flexible ureterorenoscopy (F-URS) with holmium laser versus extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stone <2 cm: a meta-analysis. Urolithiasis 2015; 44:353-65. [DOI: 10.1007/s00240-015-0832-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 10/20/2015] [Indexed: 10/22/2022]
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