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Extra-corporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculiNabi G, Downey P, Keeley FX, Watson GM, McClinton S
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SummaryPeople who undergo ureteroscopy for the treatment of ureteric stones achieve a higher stone-free rate, but have more complications and a longer hospital stayUreteral stones frequently cause renal colic (pain) and if left untreated can cause obstructive uropathy (obstruction of the urinary tract). Both ureteroscopy and ESWL achieve a high success rate in the management of ureteric stone disease. Analysis of five RCTs (732 patients) indicates a higher stone-free rate after ureteroscopy treatment but with a longer hospital stay and a higher risk of complications. However, with continuous advancements in the field of ureteroscopy and variation between trials (heterogeneity) further evaluation and research is required in this field.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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January 24. 2007 AbstractBackgroundUreteral stones frequently cause renal colic and if left untreated can cause obstructive uropathy. Extracorporeal Shock Wave Lithotripsy (ESWL) and ureteroscopy, with or without intracorporeal lithotripsy, are the two most commonly offered interventional procedures in these patients. ESWL treatment is less invasive but has some limitations such as a high retreatment rate and lack of availability in many centres. Advances in ureteroscopy over the past decade have increased the success rate and reduced complication rates. ObjectivesTo examine evidence from randomised controlled trials (RCTs) on the outcomes of ESWL or ureteroscopy in the treatment of ureteric calculi. Search strategyWe searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library Issue 2, 2006), MEDLINE (1966 - March 2006), EMBASE (1980 - March 2006), reference lists of articles and abstracts from conference proceedings without language restriction. Selection criteriaRCTs comparing ESWL with ureteroscopic retrieval of ureteric stones were included. Participants were adults with ureteric stones requiring intervention. Published and unpublished sources were considered. Data collection and analysisTwo authors independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes or mean difference (MD) for continuous data with 95% confidence intervals (CI). Main resultsFive RCTs (732 patients) were included. The stone-free rates were lower in the ESWL group (RR 0.83 95% CI 0.70 to 0.98). The retreatment rates were lower but not significant in the ureteroscopy group (RR 2.78 95% CI 0.53 to 14.71). The rate of complications was lower in the ESWL group (RR 0.44 95% CI 0.21 to 0.92). Length of hospital stay was less for ESWL treatment (MD -2.10 95% CI -2.55 to -1.64). Authors' conclusionsUreteroscopic removal of ureteral stones achieves a higher stone-free state but with a higher complication rate and a longer hospital stay. |