title: Semi-rigid ureteroscopic lithotripsy versus laparoscopic ureterolithotomy for large upper ureteral stones: a meta - analysis of randomized controlled trials.
abstract: BACKGROUND
  To provide a systematic review and meta-analysis of randomized controlled trials (RCT) comparing semi-rigid ureteroscopic lithotripsy (URS) with laparoscopic ureterolithotomy (LU) for the treatment of the large proximal ureteral stone.
  
  
  METHODS
  A systematic literature review was performed in June 2015 using the PubMed, Scopus, and Web of Science databases to identify relevant studies. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria.
  
  
  RESULTS
  Six RCT including 646 patients were analyzed, 325 URS cases (50.3%) and 321 LU cases (49.7%). URS provided a significantly shorter operative time (weighted mean difference [WMD] = -31.26 min; 95%CI -46.88 to -15.64; <0.0001) and length of hospital stay (WMD = -1.48 days; 95%CI -2.78 to -0.18; p=0.03) than LU. There were no significant differences in terms of overall complications (OR = 0.78; 95%CI 0.21-2.92; p=0.71) and major complications - Clavien ≥3 - (OR = 1.79; 95%CI 0.59-5.42; p=0.30). LU led to a significantly higher initial stone-free rate (OR = 8.65; 95%CI 4.18-17.91; p<0.00001) and final stone-free rate (OR = 6.41; 95%CI 2.24-18.32; p=0.0005) than URS. There was a significantly higher need for auxiliary procedures in URS cases (OR = 6.58; 95%CI 3.42-12.68; p<0.00001).
  
  
  CONCLUSIONS
  Outcomes with LU for larger proximal ureteral calculi are favorable compared to semi-rigid URS and should be considered as a first-line alternative if flexible ureteroscopy is not available. Utilization of flexible ureteroscopy in conjunction with semi-rigid ureteroscopy may impact these outcomes, and deserves further systematic evaluation.
authors: Departamento de Urologia do Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina São Paulo, SP, Brasil.|Stevan B. Streem Center for Endourology & Stone Disease; Glickman Urological & Kidney Institute, The Cleveland Clinic, Cleveland, OH, USA.
authors: Fabio C M
authors: FC
authors: Torricelli
authors: Stevan B. Streem Center for Endourology & Stone Disease; Glickman Urological & Kidney Institute, The Cleveland Clinic, Cleveland, OH, USA.
authors: Manoj
authors: M
authors: Monga
authors: Departamento de Urologia do Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina São Paulo, SP, Brasil.
authors: Giovanni S
authors: GS
authors: Marchini
authors: Departamento de Urologia do Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina São Paulo, SP, Brasil.
authors: Miguel
authors: M
authors: Srougi
authors: Departamento de Urologia do Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina São Paulo, SP, Brasil.
authors: William C
authors: WC
authors: Nahas
authors: Departamento de Urologia do Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina São Paulo, SP, Brasil.
authors: Eduardo
authors: E
authors: Mazzucchi
mesh_terms: D019317:Evidence-Based Medicine / Q000145:classification; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008096:Lithotripsy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014514:Ureteral Calculi / Q000473:pathology / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods*
keywords: Laparoscopy; Lithotripsy; Ureteroscopy