Systematic review and cumulative analysis of the managements for proximal impacted ureteral stones

被引:43
作者
Deng, Tuo [1 ,2 ,3 ]
Chen, Yiwen [4 ]
Liu, Bing [5 ]
Laguna, M. Pilar [6 ,7 ]
de la Rosette, Jean J. M. C. H. [6 ,7 ]
Duan, Xiaolu [1 ,2 ,3 ]
Wu, Wenqi [1 ,2 ,3 ]
Zeng, Guohua [1 ,2 ,3 ]
机构
[1] Guangzhou Med Univ, Affiliated Hosp 1, Minimally Invas Surg Ctr, Dept Urol, Kangda Rd 1, Guangzhou 510230, Guangdong, Peoples R China
[2] Guangzhou Inst Urol, Guangzhou, Guangdong, Peoples R China
[3] Guangdong Key Lab Urol, Guangzhou, Guangdong, Peoples R China
[4] Longgang Dist Cent Hosp, Dept Urol, Shenzhen, Peoples R China
[5] Jinan Univ, Affiliated Hosp 1, Dept Ophthalmol, Guangzhou, Guangdong, Peoples R China
[6] Istanbul Medipol Univ, Dept Urol, Istanbul, Turkey
[7] AMC Univ Hosp, Amsterdam, Netherlands
基金
中国国家自然科学基金; 中国博士后科学基金;
关键词
Proximal impacted ureteral stones; Managements; Systematic review; Meta-analysis; PERCUTANEOUS ANTEGRADE URETEROLITHOTRIPSY; RETROPERITONEAL LAPAROSCOPIC URETEROLITHOTOMY; MEDICAL EXPULSIVE THERAPY; URETEROSCOPIC LITHOTRIPSY; WALL THICKNESS; LASER LITHOTRIPSY; CLINICAL-EFFICACY; CM; NEPHROLITHOTOMY; CALCULI;
D O I
10.1007/s00345-018-2561-7
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose To compare the efficacy and safety of different treatment options for the management of proximal impacted ureteral stones (PIUS). Methods A systematic literature search using Pubmed, Medline, Embase and Cochrane Library was conducted to obtain studies concerning different managements for PIUS up to Jan 2018. Summary odds ratios (ORs), standard mean differences (SMDs) or weighted mean differences with their 95% confidence intervals (CIs) were calculated to compare the efficacy and safety of all included treatment methods, registered in PROSPERO under number CRD42018092745. Results A total of 15 comparative studies with 1780 patients were included. Meta-analyses of final stone-free rate (SFR) favored percutaneous nephrolithotomy (PCNL) over ureteroscopic lithotripsy (URL) (OR 10.35; 95% CI 5.26-20.35; P < 0.00001), laparoscopic ureterolithotomy over URL (OR 0.11; 95% CI 0.05-0.25; P < 0.00001) and URL over extracorporeal shockwave lithotripsy (OR 0.47; 95% CI 0.28-0.77; P = 0.003). As to complications, PCNL had a significantly higher blood transfusion rate (OR 7.47; 95% CI 1.3-42.85; P = 0.02) and a lower ureteral injury rate (OR 0.15; 95% CI 0.04-0.52; P = 0.003) compared with URL. It also shared a significantly lower stone-retropulsion rate (OR 0.03; 95% CI 0.01-0.15; P < 0.0001) and higher treatment costs (SMD = 2.71; 95% CI 0.71-4.70; P = 0.008) than URL. Conclusions Our meta-analysis suggested that PCNL might be the best option for PIUS owing to its higher successful rate. Complications such as hemorrhage could be decreased by the application on mini-PCNL.
引用
收藏
页码:1687 / 1701
页数:15
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