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Ureteroscopy in patients with bleeding diatheses, anticoagulated, and on anti-platelet agents: a systematic review and meta-analysis of the literature

Ureteroscopy in patients with bleeding diatheses, anticoagulated, and on anti-platelet agents: a systematic review and meta-analysis of the literature
Ureteroscopy in patients with bleeding diatheses, anticoagulated, and on anti-platelet agents: a systematic review and meta-analysis of the literature

INTRODUCTION: Ureteroscopy (URS) is the most common surgical treatment of urolithiasis and can be problematic in patients with a bleeding diathesis. The intent of this review is to systematically review the literature to assess the safety and efficacy of ureteroscopic procedures in these groups of patients.

METHODS: The systematic review was performed according to the Cochrane diagnostic accuracy review guidelines. The search strategy was conducted to perform a comprehensive database search (1990-2017). A cumulative analysis was done and where applicable a comparative analysis between bleeding diathesis patients and those without.

RESULTS: Eight studies included were all published between 1998 and 2016 with the total number of participants with bleeding diatheses being 1109 with an age range of 18-97. Overall stone-free rate across the studies was 90.8% vs 86.2% in the control group. There was no significant difference in complications between the bleeding diathesis group and control group (N = 12,757, p = 0.07, 95% confidence interval [CI] 0.92, 6.02, I2 = 78%). Pooled analysis for bleeding-related complications shows a statistically significant difference favoring the control arm (N = 12,757, p ≤ 0.0001, 95% CI 1.81, 5.73, I2 = 0%). Pooled analysis for thrombosis shows no statistically significant difference between the bleeding diathesis group and the control arm (N = 118, p = 0.67, 95% CI 0.23, 9.86, I2 = 48%).

CONCLUSION: The use of URS with or without the holmium laser is a safe and efficient modality for treating patients with urolithiasis who also have a bleeding diathesis or are anticoagulated or on antiplatelet agents. However, this review would suggest that the increased risk of procedure related bleeding is not insignificant and a patient-centered approach should be taken with regards to continuing these agents or not correcting bleeding diatheses.

Journal Article
0892-7790
1217-1225
Sharaf, Alaa
17af4d53-04bc-495c-b308-a0ce415a254b
Amer, Tarik
34b3aacc-a0bb-4f35-ae65-6808574e6c1f
Somani, Bhaskar K.
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Aboumarzouk, Omar M
3c7e2433-638d-4378-9931-902fdc68acce
Sharaf, Alaa
17af4d53-04bc-495c-b308-a0ce415a254b
Amer, Tarik
34b3aacc-a0bb-4f35-ae65-6808574e6c1f
Somani, Bhaskar K.
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Aboumarzouk, Omar M
3c7e2433-638d-4378-9931-902fdc68acce

Sharaf, Alaa, Amer, Tarik, Somani, Bhaskar K. and Aboumarzouk, Omar M (2017) Ureteroscopy in patients with bleeding diatheses, anticoagulated, and on anti-platelet agents: a systematic review and meta-analysis of the literature. Journal of Endourology, 31 (12), 1217-1225. (doi:10.1089/end.2017.0253).

Record type: Article

Abstract

INTRODUCTION: Ureteroscopy (URS) is the most common surgical treatment of urolithiasis and can be problematic in patients with a bleeding diathesis. The intent of this review is to systematically review the literature to assess the safety and efficacy of ureteroscopic procedures in these groups of patients.

METHODS: The systematic review was performed according to the Cochrane diagnostic accuracy review guidelines. The search strategy was conducted to perform a comprehensive database search (1990-2017). A cumulative analysis was done and where applicable a comparative analysis between bleeding diathesis patients and those without.

RESULTS: Eight studies included were all published between 1998 and 2016 with the total number of participants with bleeding diatheses being 1109 with an age range of 18-97. Overall stone-free rate across the studies was 90.8% vs 86.2% in the control group. There was no significant difference in complications between the bleeding diathesis group and control group (N = 12,757, p = 0.07, 95% confidence interval [CI] 0.92, 6.02, I2 = 78%). Pooled analysis for bleeding-related complications shows a statistically significant difference favoring the control arm (N = 12,757, p ≤ 0.0001, 95% CI 1.81, 5.73, I2 = 0%). Pooled analysis for thrombosis shows no statistically significant difference between the bleeding diathesis group and the control arm (N = 118, p = 0.67, 95% CI 0.23, 9.86, I2 = 48%).

CONCLUSION: The use of URS with or without the holmium laser is a safe and efficient modality for treating patients with urolithiasis who also have a bleeding diathesis or are anticoagulated or on antiplatelet agents. However, this review would suggest that the increased risk of procedure related bleeding is not insignificant and a patient-centered approach should be taken with regards to continuing these agents or not correcting bleeding diatheses.

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More information

e-pub ahead of print date: 1 December 2017
Published date: December 2017
Keywords: Journal Article

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Local EPrints ID: 419162
URI: http://eprints.soton.ac.uk/id/eprint/419162
ISSN: 0892-7790
PURE UUID: ca8ff35b-487c-4ef1-9847-48481ea360ed

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Date deposited: 06 Apr 2018 16:30
Last modified: 13 Mar 2019 18:44

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