A Meta-analysis of Percutaneous Nephrolithotomy versus Ureterolithotripsy in the Treatment of Impacted Proximal Ureteral Stones >1 cm_West China Medical Journal

Authors：

 TANGGuo-qiang , TANGuang-zhong , CHENWen-kai , YANGBo , TANDan , WANGJia-wu

Department of Urology, General Hospital of Chongqing Steel Company, Chongqing 400081, P. R. China;

Corresponding author：

Keywords：

Percutaneous nephrolithotomy; Ureteroscopic lithotripsy; Ureteral stones; Meta-analysi

DOI：

10.7507/1002-0179.20150413

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Objective To assess the efficacy and safety of percutaneous nephrolithotomy (PCNL) versus ureteroscopic lithotripsy (URL) in the treatment of impacted proximal ureteral stones>1 cm. Methods We electronically searched PubMed, Cochrane library, Embase, WanFang, Chinese National Knowledge Infrastructure and VIP database (by the end of July 2015) to collect randomized controlled trials involving PCNL vs. URL for the treatment of impacted proximal ureteral stones> 1 cm. The quality of those trials were assessed. Data were extracted and analyzed with RevMan 5.3 software. Results Six randomized controlled trials were finally obtained after screening. A total of 487 patients were included for a Meta-analysis. The results showed that, as compared with the control group (URL), the patients in the trial group (PCNL) had the following features: ① There was a remarkable improvement of stone clearance rate [RR=1.20, 95% CI (1.09, 1.33), P=0.000 3].② There was no statistical difference in postoperative fever rates, urinary tract perforation rates [RR=1.73, 95%CI (0.43, 7.00), P=0.45; RR=1.02, 95%CI (0.11, 9.37), P=0.99], but the incidence of hematuria was higher [RR=1.99, 95%CI (1.09, 3.62), P=0.03], and the mean operative duration was longer [WMD=30.03 minutes, 95%CI (10.04, 50.02) minuntes, P=0.003].③ The mean hospitalization stay was delayed by an average of 3.73 days [WMD=3.73 days, 95%CI (3.02, 4.44) days, P<0.000 01]. Conclusion PCNL is better than URL in the stone clearance rate, while patients in the PCNL group have to stay in the hospital much longer, and should bear longer mean operative duration.

Citation： TANGGuo-qiang, TANGuang-zhong, CHENWen-kai, YANGBo, TANDan, WANGJia-wu. A Meta-analysis of Percutaneous Nephrolithotomy versus Ureterolithotripsy in the Treatment of Impacted Proximal Ureteral Stones >1 cm. West China Medical Journal, 2015, 30(8): 1435-1441. doi: 10.7507/1002-0179.20150413 Copy

1.	Papadoukakis S, Stolzenburg JU, Truss MC. Treatment strategies of ureteral stones[J]. EAU-EBU Update Series, 2006, 4(5): 184-190.
2.	那彦群, 叶章群, 孙颖浩,等. 中国泌尿外科疾病诊断治疗指南[M]. 北京: 人民卫生出版社, 2014: 185-194.
3.	Preminger GM, Tiselius HG, Assimos DG, et al.2007 guideline for the management of ureteral calculi[J]. J Urol, 2007, 178(6): 2418-2434.
4.	Huri E, Tatar I, Germiyanoglu C, et al. Evaluation of urinary stones ex vivo with micro-computed tomography: preliminary results of an investigational technique[J]. Urol J, 2011, 8(3): 185-190.
5.	Liu DY, He HC, Wang J, et al. Ureteroscopic lithotripsy using Holmium laser for 187 patients with proximal ureteral stones[J]. Chin Med J (Engl), 2012, 125(9): 1542-1546.
6.	Lopes Neto AC, Korkes F, Silva JL, et al. Prospective randomized study of treatment of large proximal ureteral stones: extracorporeal shock wave lithotripsy versus ureterolithotripsy versus laparoscopy[J]. J Urol, 2012, 187(1): 164-168.
7.	Karami H, Arbab AH, Hosseini SJ, et al. Impacted Upper-Ureteral calculi>1 cm: blind access and totally tubeless percutaneous antegrade removal or retrograde approach?[J]. J Endourol, 2006, 20(9): 616-619.
8.	Basiri A, Simforoosh N, Ziaee A, et al. Retrograde, antegrade, and laparoscopic approaches for the management of large, proximal ureteral stones: a randomized clinical trial[J]. J Endourol, 2008, 22(12): 2677-2680.
9.	Sun X, Xia S, Lu J, et al. Treatment of large impacted proximal ureteral stones: randomized comparison of percutaneous antegrade ureterolithotripsy versus retrograde ureterolithotripsy[J]. J Endourol, 2008, 22(5): 913-917.
10.	李程, 黄恒海, 李仙, 等. 210例复杂性输尿管上段结石治疗分析[J]. 广西医学, 2010, 32(9): 1085-1087.
11.	王金善. 经皮肾镜超声气压弹道碎石术治疗输尿管上段嵌顿性结石疗效观察[J]. 山东医药, 2012, 52(10): 69-70.
12.	刘磊, 李鹏, 胡跃世, 等. 微创经皮肾穿刺取石术与经尿道输尿管镜碎石术对输尿管上段结石的疗效对比[J]. 现代预防医学, 2012, 39(11): 2913-2914, 2921.
13.	Juan YS, Shen JT, Li CC, et al. Comparison of percutaneous nephrolithotomy and ureteroscopic lithotripsy in the management of impacted, large, proximal ureteral stones[J]. Kaohsiung J Med Sci, 2008, 24(4): 204-209.
14.	Gu XJ, Lu JL, Xu Y. Treatment of large impacted proximal ureteral stones: randomized comparison of minimally invasive percutaneous antegrade ureterolithotripsy versus retrograde ureterolithotripsy[J]. World J Urol, 2013, 31(6): 1605-1610.
15.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions[M]. Chichester: John Wiley & Sons Ltd, 2008: 187-388.
16.	Hemal AK, Goel A, Goel R. Minimally invasive retroperitoneoscopic ureterolithotomy[J]. J Urol, 2003, 169(2): 480-482.
17.	Goel R, Aron M, Kesarwani PK, et al. Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries[J]. J Endourol, 2005, 19(1): 54-57.
18.	Elganainy E, Hameed DA, Elgammal M, et al. Experience with impacted upper ureteral stones; should we abandon using semirigid ureteroscopes and pneumatic lithoclast?[J]. Int Arch Med, 2009, 2(1): 13.
19.	李逊, 雷鸣, 袁坚, 等. 微创经皮肾穿刺取石和经尿道输尿管镜碎石治疗嵌顿性输尿管上段结石的疗效比较[J]. 临床泌尿外科杂志, 2004, 19(7): 388-390.
20.	Kurien A, Baishya R, Mishra S, et al. The impact of percutaneous nephrolithotomy in patients with chronic kidney disease[J]. J Endourol, 2009, 23(9): 1403-1407.
21.	Jiang H, Wu Z, Ding Q, et al. Ureteroscopic treatment of ureteral calculi with Holmium: YAG laser lithotripsy[J]. J Endourol, 2007, 21(2): 151-154.
22.	唐国强, 李茂生, 钱源江. 系统评价输尿管碎石术联合阻石网篮治疗输尿管上段结石的价值[J]. 重庆医科大学学报, 2013, 38(12): 1471-1475.
23.	Ding H, Wang ZP, Du W, et al. NTrap in prevention of stone migration during ureteroscopic lithotripsy for proximal ureteral stones: a Meta-analysis[J]. J Endourol, 2012, 26(2): 130-134.

1. Papadoukakis S, Stolzenburg JU, Truss MC. Treatment strategies of ureteral stones[J]. EAU-EBU Update Series, 2006, 4(5): 184-190.
2. 那彦群, 叶章群, 孙颖浩,等. 中国泌尿外科疾病诊断治疗指南[M]. 北京: 人民卫生出版社, 2014: 185-194.
3. Preminger GM, Tiselius HG, Assimos DG, et al.2007 guideline for the management of ureteral calculi[J]. J Urol, 2007, 178(6): 2418-2434.
4. Huri E, Tatar I, Germiyanoglu C, et al. Evaluation of urinary stones ex vivo with micro-computed tomography: preliminary results of an investigational technique[J]. Urol J, 2011, 8(3): 185-190.
5. Liu DY, He HC, Wang J, et al. Ureteroscopic lithotripsy using Holmium laser for 187 patients with proximal ureteral stones[J]. Chin Med J (Engl), 2012, 125(9): 1542-1546.
6. Lopes Neto AC, Korkes F, Silva JL, et al. Prospective randomized study of treatment of large proximal ureteral stones: extracorporeal shock wave lithotripsy versus ureterolithotripsy versus laparoscopy[J]. J Urol, 2012, 187(1): 164-168.
7. Karami H, Arbab AH, Hosseini SJ, et al. Impacted Upper-Ureteral calculi>1 cm: blind access and totally tubeless percutaneous antegrade removal or retrograde approach?[J]. J Endourol, 2006, 20(9): 616-619.
8. Basiri A, Simforoosh N, Ziaee A, et al. Retrograde, antegrade, and laparoscopic approaches for the management of large, proximal ureteral stones: a randomized clinical trial[J]. J Endourol, 2008, 22(12): 2677-2680.
9. Sun X, Xia S, Lu J, et al. Treatment of large impacted proximal ureteral stones: randomized comparison of percutaneous antegrade ureterolithotripsy versus retrograde ureterolithotripsy[J]. J Endourol, 2008, 22(5): 913-917.
10. 李程, 黄恒海, 李仙, 等. 210例复杂性输尿管上段结石治疗分析[J]. 广西医学, 2010, 32(9): 1085-1087.
11. 王金善. 经皮肾镜超声气压弹道碎石术治疗输尿管上段嵌顿性结石疗效观察[J]. 山东医药, 2012, 52(10): 69-70.
12. 刘磊, 李鹏, 胡跃世, 等. 微创经皮肾穿刺取石术与经尿道输尿管镜碎石术对输尿管上段结石的疗效对比[J]. 现代预防医学, 2012, 39(11): 2913-2914, 2921.
13. Juan YS, Shen JT, Li CC, et al. Comparison of percutaneous nephrolithotomy and ureteroscopic lithotripsy in the management of impacted, large, proximal ureteral stones[J]. Kaohsiung J Med Sci, 2008, 24(4): 204-209.
14. Gu XJ, Lu JL, Xu Y. Treatment of large impacted proximal ureteral stones: randomized comparison of minimally invasive percutaneous antegrade ureterolithotripsy versus retrograde ureterolithotripsy[J]. World J Urol, 2013, 31(6): 1605-1610.
15. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions[M]. Chichester: John Wiley & Sons Ltd, 2008: 187-388.
16. Hemal AK, Goel A, Goel R. Minimally invasive retroperitoneoscopic ureterolithotomy[J]. J Urol, 2003, 169(2): 480-482.
17. Goel R, Aron M, Kesarwani PK, et al. Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries[J]. J Endourol, 2005, 19(1): 54-57.
18. Elganainy E, Hameed DA, Elgammal M, et al. Experience with impacted upper ureteral stones; should we abandon using semirigid ureteroscopes and pneumatic lithoclast?[J]. Int Arch Med, 2009, 2(1): 13.
19. 李逊, 雷鸣, 袁坚, 等. 微创经皮肾穿刺取石和经尿道输尿管镜碎石治疗嵌顿性输尿管上段结石的疗效比较[J]. 临床泌尿外科杂志, 2004, 19(7): 388-390.
20. Kurien A, Baishya R, Mishra S, et al. The impact of percutaneous nephrolithotomy in patients with chronic kidney disease[J]. J Endourol, 2009, 23(9): 1403-1407.
21. Jiang H, Wu Z, Ding Q, et al. Ureteroscopic treatment of ureteral calculi with Holmium: YAG laser lithotripsy[J]. J Endourol, 2007, 21(2): 151-154.
22. 唐国强, 李茂生, 钱源江. 系统评价输尿管碎石术联合阻石网篮治疗输尿管上段结石的价值[J]. 重庆医科大学学报, 2013, 38(12): 1471-1475.
23. Ding H, Wang ZP, Du W, et al. NTrap in prevention of stone migration during ureteroscopic lithotripsy for proximal ureteral stones: a Meta-analysis[J]. J Endourol, 2012, 26(2): 130-134.

West China Medical Journal

A Meta-analysis of Percutaneous Nephrolithotomy versus Ureterolithotripsy in the Treatment of Impacted Proximal Ureteral Stones >1 cm

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