title: Comparison between extracorporeal shock wave lithotripsy and ureteroscopic lithotripsy for treating large proximal ureteral stones: a meta-analysis.
abstract: OBJECTIVE
  To compare extracorporeal shock wave lithotripsy (ESWL) and ureteroscopic lithotripsy (URSL) in terms of efficacy, complications, and overall efficiency in the management of proximal ureteral calculi. ESWL and URSL are the 2 most common modalities for treating ureteral stones. Previous studies and meta-analyses suggest that for stones <10 mm, ESWL is safer and of comparable efficacy compared with URSL. However, the choice between one modality over the other for the treatment of stones >10 mm is not as clear.
  
  
  METHODS
  The literature was reviewed in the databases, and resulting reports were screened for relevance. This process yielded 10 articles, which were analyzed in terms of the initial stone-free rate (primary outcome measure) compared between the 2 treatment modalities. Pretreatment rate, operation time, auxiliary procedure rate, and complication rate constituted secondary measures in the analysis.
  
  
  RESULTS
  A statistically higher initial stone-free rate was demonstrated for URSL compared with ESWL (odds ratio [OR] = 0.349; 95% confidence interval [CI] = 0.183-0.666; P = .001). ESWL showed a statistically higher retreatment rate compared with URSL (OR = 7.192; 95% CI = 4.934-10.482; P <.001). The 2 treatment modalities did not show statistically significant differences in mean operating time (OR = 10.35; 95% CI = -0.29 to 20.99; P = .056), auxiliary procedure rate (OR = 1.043; 95% CI = 0.415-2.616; P = .929), or in the complication rate (OR = 0.78; 95% CI = 0.304-1.984; P = .598).
  
  
  CONCLUSIONS
  For treating large (>10 mm) proximate ureteral stones, URSL tends to be more effective than ESWL, yet without adding significant risk.
authors: Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors: Xin
authors: X
authors: Cui
authors: Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors: Fan
authors: F
authors: Ji
authors: Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors: Hao
authors: H
authors: Yan
authors: Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China. Electronic address: outongwen@sohu.com.
authors: Tong-Wen
authors: TW
authors: Ou
authors: Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors: Chun-Song
authors: CS
authors: Jia
authors: Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors: Xin-Zhou
authors: XZ
authors: He
authors: Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors: Wei
authors: W
authors: Gao
authors: Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors: Qi
authors: Q
authors: Wang
authors: Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors: Bo
authors: B
authors: Cui
authors: Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors: Jiang-Tao
authors: JT
authors: Wu
mesh_terms: D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000473:pathology / Q000628:therapy*; D018666:Ureteroscopy