title: Flexible ureterorenoscopy (F-URS) with holmium laser versus extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stone <2 cm: a meta-analysis.
abstract: The objective of the study was to systematically review the efficacy and safety of flexible ureterorenoscopy (F-URS) with holmium laser versus extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal stone <2 cm. A systematic literature review was performed in April 2015 using the PubMed, Embase, Web of Science and the Chinese Biomedical Literature (CNKI and Wanfang) databases to identify relevant studies. All clinical trials were retrieved and their included references investigated. Two reviewers independently assessed the quality of all included studies, and the eligible studies were included and analyzed using the RevMan 5.3 software. Six prospective randomized comparison trials and eight retrospective comparison trials were included, involving a total of 2348 patients. For renal stone 1-2 cm, F-URS technique provided a significantly higher stone-free rate (SFR) [weighted mean difference (WMD) = 2.35, 95 % confidence interval (CI) 1.65-3.34, P < 0.00001], lower auxiliary procedure rate (APR) [odds ratio (OR) 0.33, 95 % CI 0.22-0.50, P < 0.00001] and lower retreatment rate (RR) (OR 0.07, 95 % CI 0.01-0.37, P = 0.002). Similar results were found in the lower pole stone for 1-2 cm subgroup. For renal stone <1 cm, F-URS technique also showed a significantly higher SFR than ESWL (WMD = 2.13, 95 % CI 1.13-4.00, P = 0.02). F-URS is associated with higher SFR, lower APR and RR than ESWL. F-URS is a safe and effective procedure. It can successfully treat patients with stones for 1-2 cm, especially for lower pole stone, without increasing complications, operative time and hospital stay. F-URS can be used as an alternative treatment to ESWL in selected cases with larger renal stones. However, further randomized trials are needed to confirm these findings.
authors.affiliation: Department of Urology, Third Affiliated Hospital of Nantong University, Wuxi, Jiangsu, China.
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Mi
authors.affiliation: Department of Orthopedics, The Affiliated Jiangyin Hospital of Southeast University Medical School, Wuxi, Jiangsu, China.
authors.forename: Kewei
authors.initials: K
authors.lastname: Ren
authors.affiliation: Department of Urology, Third Affiliated Hospital of Nantong University, Wuxi, Jiangsu, China.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Pan
authors.affiliation: Department of Urology, Third Affiliated Hospital of Nantong University, Wuxi, Jiangsu, China. zhulijiemeta@hotmail.com.
authors.forename: Lijie
authors.initials: L
authors.lastname: Zhu
authors.affiliation: Department of Urology, Third Affiliated Hospital of Nantong University, Wuxi, Jiangsu, China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Wu
authors.affiliation: Department of Urology, Third Affiliated Hospital of Nantong University, Wuxi, Jiangsu, China.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: You
authors.affiliation: Department of Urology, Third Affiliated Hospital of Nantong University, Wuxi, Jiangsu, China.
authors.forename: Hongbao
authors.initials: H
authors.lastname: Shao
authors.affiliation: Department of Urology, Third Affiliated Hospital of Nantong University, Wuxi, Jiangsu, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Dai
authors.affiliation: Department of Urology, Third Affiliated Hospital of Nantong University, Wuxi, Jiangsu, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Peng
authors.affiliation: Department of Urology, Third Affiliated Hospital of Nantong University, Wuxi, Jiangsu, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Qin
authors.affiliation: Department of Urology, Third Affiliated Hospital of Nantong University, Wuxi, Jiangsu, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Urology, Third Affiliated Hospital of Nantong University, Wuxi, Jiangsu, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Huang
mesh_terms: D006801:Humans; D007669:Kidney Calculi / Q000473:pathology / Q000601:surgery*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008096:Lithotripsy; D020709:Ureteroscopes; D018666:Ureteroscopy
keywords: Extracorporeal shock wave lithotripsy; Flexible ureterorenoscopy; Lower pole stone; Meta-analysis; Renal stone; Stone-free