OBJECTIVE: To compare the effectiveness of various treatments used for lower pole renal calculi.
METHODS: We searched PubMed, EMBASE, CINAHL, the Cochrane Collaboration's Database of Systematic Reviews, the Cochrane Collaboration Central Register of Controlled Clinical Trials as well as ClinicalTrials.gov for reports up to April 1, 2014. Search was supplemented with abstract reports from various urology conferences. All randomised, blinded clinical studies including patients treated for lower pole renal calculi < 20mm were included for review. Two authors independently reviewed 5,194 articles identified and selected 13 trials for analysis. Network meta-analysis was performed to generate comparative statistics while quality was assessed with Jadad composite scale and risk of bias.
RESULTS: All treatment modalities examined: percutaneous nephrolithtripsy (PNL), ureterenoscopy (URS) and shockwave lithotripsy with adjuvant therapy such as inversion, hydration and forced diuresis (SWL & Adj) were more effective than shockwave lithotripsy (SWL) therapy alone, with risk ratio (95% confidence intervals) of being stone free: PNL 2.19 (1.62-2.96); URS 1.23 (1.03-1.48); and SWL & Adj 1.30 (1.03-1.63). However, patients treated with other treatment modalities also have a higher risk of adverse events compared with SWL therapy, but there was no evidence of a convincing difference between the various techniques and adverse events.
CONCLUSION: In stones < 10mm, SWL & Adj appears to have better stone clearance , lower risk of adverse events and need for further treatment. PNL was most effective treatment in larger sized stones, after considering both efficacy and safety of treatment. These should be considered by both physicians and patients alike when considering on the choice of treatment and in the revision of clinical practice guidelines.
Written by:
Lee SW, Chaiyakunapruk N, Chong HY, Liong ML. Are you the author?
School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.
Reference: BJU Int. 2014 Nov 10. Epub ahead of print.
doi: 10.1111/bju.12983
PubMed Abstract
PMID: 25381743