Flexible ureteroscopy and laser lithotripsy for stones >2 cm: a systematic review and meta-analysis.
OBJECTIVE
Urinary stones >2 cm are traditionally managed with percutaneous nephrolithotomy (PCNL). Recently, flexible ureteroscopy and laser lithotripsy) (FURSL) has been used to manage them with comparable results. In a comparative study of renal stones between 2 and 3 cm, FURSL was reported to need less second-stage procedures and be just as effective as PCNL. Our purpose was to review the literature for renal stones >2 cm managed by ureteroscopy and holmium lasertripsy.


METHODS
A systematic review and quantitative meta-analysis was performed using studies identified by a literature search from 1990s (the first reported large renal stones treated ureteroscopically) to August 2011. All English language articles reporting on a minimum of 10 patients treated with FURSL for renal stones >2 cm were included. Two reviewers independently extracted the data from each study. The data of studies with comparable results were included into a meta-analysis.


RESULTS
In nine studies, 445 patients (460 renal units) were reportedly treated with FURSL. The mean operative time was 82.5 minutes (28-215 min). The mean stone-free rate was 93.7% (77%-96.7%), with an average of 1.6 procedures per patient. The mean stone size was 2.5 cm. An overall complication rate was 10.1%. Major complications developed in 21 (5.3%) patients and minor complications developed in 19 (4.8%) patients. A subgroup analysis shows that FURSL has a 95.7% stone-free rate with stones 2-3 cm and 84.6% in those >3 cm (P=0.01), with a minor complication rate of 14.3% and 15.4%, respectively, and a major complication rate of 0% and 11.5%, respectively.


CONCLUSIONS
In experienced hands, FURSL can successfully treat patients with stones >2 cm with a high stone-free rate and a low complication rate. Although the studies are from high-volume experienced centers and may not be sufficient to alter everyday routine practice, this review has shown that the efficacy of FURSL allows an alternative to PCNL.
Department of Urology, Royal Bournemouth Hospital, Bournemouth, United Kingdom. aboumarzouk@gmail.com
Omar M
OM
Aboumarzouk
Manoj
M
Monga
Slawomir G
SG
Kata
Olivier
O
Traxer
Bhaskar K
BK
Somani
D006801:Humans; D007669:Kidney Calculi / Q000175:diagnosis / Q000628:therapy*; D017602:Lithotripsy, Laser / Q000379:methods*; D012720:Severity of Illness Index; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000379:methods*