Comparative effectiveness and safety of various treatment procedures for lower pole renal calculi: a systematic review and network meta-analysis.
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 1 April 2014. The search was supplemented with abstract reports from various urology conferences. All randomised, 'blinded' clinical studies including patients treated for lower pole renal calculi of <20 mm were included for review. Two authors independently reviewed 5 194 articles, and identified and selected 13 trials for analysis. Network meta-analysis was performed to generate comparative statistics, while quality was assessed with the Jadad composite scale and risk of bias.


RESULTS
All treatment methods examined: percutaneous nephrolithotomy (PNL), ureterorenoscopy (URS) and extracorporeal shockwave lithotripsy (SWL) with an adjuvant therapy (such as inversion, hydration and forced diuresis) were more effective than SWL therapy alone, with risk ratios (95% confidence intervals) of being stone free of: PNL 2.19 (1.62-2.96); URS 1.23 (1.03-1.48); and SWL with an adjuvant therapy 1.30 (1.03-1.63). However, patients treated with the other treatment methods also had a higher risk of adverse events (AEs) compared with SWL, but there was no evidence of a convincing difference between the various techniques and AEs.


CONCLUSIONS
In stones of <10 mm, SWL with an adjuvant therapy appears to have better stone clearance, lower risk of AEs, and need for further treatment. PNL was most effective treating larger stones, after considering both effectiveness and safety of treatment. These should be considered by both physicians and patients alike when considering the choice of treatment and in the revision of clinical practice guidelines.
School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.
Shaun Wen-Huey
SW
Lee
School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.|School of Population Health, University of Queensland, Brisbane, Qld, Australia.|Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.|School of Pharmacy, University of Wisconsin, Madison, WI, USA.
Nathorn
N
Chaiyakunapruk
School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.
Huey-Yi
HY
Chong
Department of Urology, Island Hospital, Penang, Malaysia.
Men-Long
ML
Liong
D000328:Adult; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008096:Lithotripsy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D055815:Young Adult
lithotripsy; lower pole kidney calculi; lower pole renal calculi; percutaneous nephrolithotomy; ureterorenoscopy