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Minimally invasive surgical ureterolithotomy versus ureteroscopic lithotripsy for large ureteric stones: a systematic review and meta-analysis of the literature

Minimally invasive surgical ureterolithotomy versus ureteroscopic lithotripsy for large ureteric stones: a systematic review and meta-analysis of the literature
Minimally invasive surgical ureterolithotomy versus ureteroscopic lithotripsy for large ureteric stones: a systematic review and meta-analysis of the literature

CONTEXT: The management of large ureteric stones represents a technical and clinical challenge.

OBJECTIVE: To investigate the safety and efficacy of minimally invasive surgical ureterolithotomy (MISU) in comparison with ureteroscopic lithotripsy (URS) for the treatment of large ureteric stones.

EVIDENCE ACQUISITION: The Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines were followed for the conduction of the study, which was registered in the PROSPERO database. Search string was "(laparoscop* OR retroperito* OR robot*) AND ureterolitho*"; database scope included PubMed, SCOPUS, Cochrane, and EMBASE. Primary end points were the stone-free (SFR) and complications rates. Secondary end points included operative time and hospital stay. Subgroup analyses were performed for stones 1-2 and >2cm, as well as different lithotripters and ureteroscopes. Meta-analysis and forest-plot diagrams were performed with the RevMan 5.3.5 software.

EVIDENCE SYNTHESIS: After screening 673 publications, seven randomized controlled trials were eligible to be included in the meta-analysis. A total of 778 patients were pooled after the elimination of the dropouts. No robotic cohorts were found. Only upper ureteral stones were treated in the included studies. The SFR at discharge and 3 mo was higher with MISU with odds ratios of 6.30 (95% confidence interval [CI]: 3.05, 13.01; I2=0%) and 5.34 (95% CI: 2.41, 8.81; I2=0%), respectively. The most common complications for MISU and URS were conversion to open surgery and stone migration to the renal pelvis, respectively. Favorable results in terms of operative time were observed in the case of URS with a mean difference of 29.5min (95% CI: 14.74, 44.26; I2=98%). Hospitalization time was favorable in the case of URS with a mean difference of 2.08 days (95% CI: 0.96, 3.20; I2=99%).

CONCLUSIONS: This meta-analysis showed a significantly higher SFR at discharge and 3 mo for MISU in comparison with URS when upper ureteral stones were treated. Operative and hospitalization time favored URS over MISU.

PATIENT SUMMARY: The current study investigated the literature on the minimally invasive management of large ureteric stones. The available evidence shows that both ureteroscopic lithotripsy and minimally invasive surgical ureterolithotomy could be considered for the treatment of these stones with similar results. The selection of the approach should be based on the advantages and disadvantages of each technique.

Journal Article, Review
554-566
Kallidonis, Panagiotis
85038e98-6c7a-487b-8b9d-839fabb84ada
Ntasiotis, Panteleimon
37fe468d-adab-4247-b336-30eba783bfac
Knoll, Thomas
67d55189-714e-4a74-9cb6-44b3fa05114e
Sarica, Kemal
19e388bc-ed93-42f8-8756-62e7d46dbf08
Papatsoris, Athanasios
51d6441b-1179-4c39-8ecb-019ad358111f
Somani, Bhaskar K
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Greco, Francesco
105d81e2-d2fc-4fd5-bef4-118f1d180675
Aboumarzouk, Omar M
3c7e2433-638d-4378-9931-902fdc68acce
Álvarez-Maestro, Mario
23ecd942-a580-4bf1-af4a-387d575c3411
Sanguedolce, Francesco
fb1c420b-414c-420c-9386-5b869f9a0884
Kallidonis, Panagiotis
85038e98-6c7a-487b-8b9d-839fabb84ada
Ntasiotis, Panteleimon
37fe468d-adab-4247-b336-30eba783bfac
Knoll, Thomas
67d55189-714e-4a74-9cb6-44b3fa05114e
Sarica, Kemal
19e388bc-ed93-42f8-8756-62e7d46dbf08
Papatsoris, Athanasios
51d6441b-1179-4c39-8ecb-019ad358111f
Somani, Bhaskar K
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Greco, Francesco
105d81e2-d2fc-4fd5-bef4-118f1d180675
Aboumarzouk, Omar M
3c7e2433-638d-4378-9931-902fdc68acce
Álvarez-Maestro, Mario
23ecd942-a580-4bf1-af4a-387d575c3411
Sanguedolce, Francesco
fb1c420b-414c-420c-9386-5b869f9a0884

Kallidonis, Panagiotis, Ntasiotis, Panteleimon, Knoll, Thomas, Sarica, Kemal, Papatsoris, Athanasios, Somani, Bhaskar K, Greco, Francesco, Aboumarzouk, Omar M, Álvarez-Maestro, Mario and Sanguedolce, Francesco (2017) Minimally invasive surgical ureterolithotomy versus ureteroscopic lithotripsy for large ureteric stones: a systematic review and meta-analysis of the literature. European Urology Focus, 3 (6), 554-566. (doi:10.1016/j.euf.2017.04.006).

Record type: Review

Abstract

CONTEXT: The management of large ureteric stones represents a technical and clinical challenge.

OBJECTIVE: To investigate the safety and efficacy of minimally invasive surgical ureterolithotomy (MISU) in comparison with ureteroscopic lithotripsy (URS) for the treatment of large ureteric stones.

EVIDENCE ACQUISITION: The Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines were followed for the conduction of the study, which was registered in the PROSPERO database. Search string was "(laparoscop* OR retroperito* OR robot*) AND ureterolitho*"; database scope included PubMed, SCOPUS, Cochrane, and EMBASE. Primary end points were the stone-free (SFR) and complications rates. Secondary end points included operative time and hospital stay. Subgroup analyses were performed for stones 1-2 and >2cm, as well as different lithotripters and ureteroscopes. Meta-analysis and forest-plot diagrams were performed with the RevMan 5.3.5 software.

EVIDENCE SYNTHESIS: After screening 673 publications, seven randomized controlled trials were eligible to be included in the meta-analysis. A total of 778 patients were pooled after the elimination of the dropouts. No robotic cohorts were found. Only upper ureteral stones were treated in the included studies. The SFR at discharge and 3 mo was higher with MISU with odds ratios of 6.30 (95% confidence interval [CI]: 3.05, 13.01; I2=0%) and 5.34 (95% CI: 2.41, 8.81; I2=0%), respectively. The most common complications for MISU and URS were conversion to open surgery and stone migration to the renal pelvis, respectively. Favorable results in terms of operative time were observed in the case of URS with a mean difference of 29.5min (95% CI: 14.74, 44.26; I2=98%). Hospitalization time was favorable in the case of URS with a mean difference of 2.08 days (95% CI: 0.96, 3.20; I2=99%).

CONCLUSIONS: This meta-analysis showed a significantly higher SFR at discharge and 3 mo for MISU in comparison with URS when upper ureteral stones were treated. Operative and hospitalization time favored URS over MISU.

PATIENT SUMMARY: The current study investigated the literature on the minimally invasive management of large ureteric stones. The available evidence shows that both ureteroscopic lithotripsy and minimally invasive surgical ureterolithotomy could be considered for the treatment of these stones with similar results. The selection of the approach should be based on the advantages and disadvantages of each technique.

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e-pub ahead of print date: 26 April 2017
Published date: December 2017
Keywords: Journal Article, Review

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Local EPrints ID: 418991
URI: http://eprints.soton.ac.uk/id/eprint/418991
PURE UUID: 7dd72cd5-ad0d-4a49-9206-6aaa6986e067

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Date deposited: 27 Mar 2018 16:30
Last modified: 15 Jan 2020 17:47

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