title: Retrograde Intrarenal Surgery Versus Percutaneous Nephrolithotomy Versus Extracorporeal Shockwave Lithotripsy for Treatment of Lower Pole Renal Stones: A Meta-Analysis and Systematic Review.
abstract: OBJECTIVE
  The optimal treatment of patients with lower pole renal stones continues to be a dilemma for urologists. Retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and extracorporeal shockwave lithotripsy (SWL) all constitute viable therapeutic options in selected patients. The aim of this study was to assess the efficacy and safety of RIRS, PCNL, and SWL in management of lower pole renal stones.
  
  
  METHODS
  A literature search was performed in July 2014 using PubMed, Embase, and Web of Science databases. Literature reviewed included meta-analysis and randomized and nonrandomized controlled studies to identify relevant studies for the meta-analysis.
  
  
  RESULTS
  Six randomized and eight nonrandomized studies were identified for analysis. PCNL provided a significantly higher stone-free rate (SFR) compared with RIRS and SWL. Furthermore, no statistical significant difference was found when PCNL was compared with RIRS and SWL for complication rate. Compared with the other two treatments, RIRS had a longer operative time and PCNL had a longer hospital stay. SWL was associated with significantly higher re-treatment rate compared with RIRS and PCNL, whereas there were no significant differences in auxiliary procedure rates among the three treatment techniques.
  
  
  CONCLUSIONS
  RIRS offers a relative higher SFR while it has a longer operative time. PCNL is associated with the highest SFR at the expense of the longest hospital stay. SWL is performed as an outpatient procedure with a relative shorter operative time; however, it has lower a SFR and higher re-treatment rate. The categories of complications vary while the overall complication rates are comparable among the three treatment techniques.
authors.affiliation: 1 Department of Urology, Changhai Hospital, Second Military Medical University , Shanghai, China .
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: 1 Department of Urology, Changhai Hospital, Second Military Medical University , Shanghai, China .
authors.forename: Tie
authors.initials: T
authors.lastname: Zhou
authors.affiliation: 2 Laboratory of Stress Medicine, Faculty of Psychology and Mental Health, Second Military Medical University , Shanghai, China .
authors.forename: Tengyun
authors.initials: T
authors.lastname: Wu
authors.affiliation: 1 Department of Urology, Changhai Hospital, Second Military Medical University , Shanghai, China .
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Gao
authors.affiliation: 1 Department of Urology, Changhai Hospital, Second Military Medical University , Shanghai, China .
authors.forename: Yonghan
authors.initials: Y
authors.lastname: Peng
authors.affiliation: 1 Department of Urology, Changhai Hospital, Second Military Medical University , Shanghai, China .
authors.forename: Chuanliang
authors.initials: C
authors.lastname: Xu
authors.affiliation: 3 Department of Health Statistics, Faculty of Health Service, Second Military Medical University , Shanghai, China .
authors.forename: Qi
authors.initials: Q
authors.lastname: Chen
authors.affiliation: 1 Department of Urology, Changhai Hospital, Second Military Medical University , Shanghai, China .
authors.forename: Ruixiang
authors.initials: R
authors.lastname: Song
authors.affiliation: 1 Department of Urology, Changhai Hospital, Second Military Medical University , Shanghai, China .
authors.forename: Yinghao
authors.initials: Y
authors.lastname: Sun
mesh_terms: D002986:Clinical Trials as Topic; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy / Q000379:methods*; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D061646:Operative Time; D018579:Patient Selection; D019233:Retreatment / Q000706:statistics & numerical data; D012449:Safety; D016896:Treatment Outcome