Treatment of Bladder Stones in Adults and Children: A Systematic Review and Meta-analysis on Behalf of the European Association of Urology Urolithiasis Guideline Panel

James F. Donaldson (Corresponding Author), Yasir Ruhayel, Andreas Skolarikos, Steven MacLennan, Yuhong Yuan, Robert Shepherd, Kay Thomas, Christian Seitz, Aleš Petřík, Christian Türk, Andreas Neisius

Research output: Contribution to journalArticle

Abstract

Context:

Bladder stones (BS) constitute 5% of urinary stones. Currently, there is no systematic review on their treatment.

Objective:

To assess the efficacy (primary outcome: stone-free rate; SFR) and morbidity of BS treatments.

Evidence Acquisition:


This systematic review was conducted in accordance with the EAU Guidelines Office. Database searches (1970-2019) were screened, abstracted and assessed for risk of bias for comparative RCTs and non-randomized studies (NRS) with ³10 patients per group. Quality of evidence (QoE) was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

Evidence Synthesis:

2742 abstracts and 59 full-texts were assessed: 25 studies (2340 patients) were included. In adults, one RCT found a lower SFR following shock wave lithotripsy (SWL) than transurethral cystolithotripsy (TUCL) (RR 0.88, p=0.03; low QoE). Four RCTs compared TUCL vs. percutaneous cystolithotripsy (PCCL): meta-analyses demonstrated no difference in SFR, but hospital stay (mean difference; MD; 0.82days, p<0.00001) and procedure duration (MD 9.83minutes, p<0.00001) favored TUCL (moderate QoE).

Four NRS comparing open cystolithotomy (CL) vs. TUCL or PCCL found no difference in SFR; hospital stay and procedure duration favored endoscopic surgery (very low QoE). Four RCTs compared TUCL using a nephroscope vs. cystoscope: meta-analyses demonstrated no difference in SFR; procedure duration favored using a nephroscope (MD 22.74 minutes, p<0.00001; moderate QoE).

In children, one NRS showed lower SFR following SWL than TUCL or CL. Two NRS comparing CL vs. TUCL/PCCL found similar SFRs; catheterization time and hospital stay favored endoscopic treatments. One RCT comparing laser vs. pneumatic TUCL found no difference in SFR. One large NRS comparing CL techniques found a shorter hospital stay after tubeless CL in selected cases, QoE was very low.

Conclusion

Current available evidence indicates TUCL is the intervention of choice for BS in adults and children, where feasible. Further high quality research on the topic is required.
Original languageEnglish
Pages (from-to)352-367
Number of pages16
JournalEuropean Urology
Volume76
Issue number3
Early online date13 Jul 2019
DOIs
Publication statusPublished - Sep 2019

Fingerprint

Urinary Bladder Calculi
Urolithiasis
Meta-Analysis
Length of Stay
Guidelines
Lithotripsy
Cystoscopes
Urinary Calculi
Therapeutics
Catheterization
Lasers
Databases
Morbidity
Research

Keywords

  • Bladder stones
  • Transurethral cystolithotripsy
  • Percutaneous cystolithotripsy
  • Open cystolithotomy
  • Adults
  • Children
  • Stone-free rates
  • Endoscopic treatments
  • MANAGEMENT
  • LITHIASIS
  • CYSTOLITHOLAPAXY
  • PERCUTANEOUS SUPRAPUBIC CYSTOLITHOTRIPSY
  • VESICAL CALCULI
  • OPEN SURGERY
  • HOYAG LASER
  • DIFFERENT ENDOSCOPIC TECHNIQUES
  • COMPLICATIONS
  • TRANSURETHRAL RESECTION

ASJC Scopus subject areas

  • Urology

Cite this

Treatment of Bladder Stones in Adults and Children : A Systematic Review and Meta-analysis on Behalf of the European Association of Urology Urolithiasis Guideline Panel. / Donaldson, James F. (Corresponding Author); Ruhayel, Yasir; Skolarikos, Andreas; MacLennan, Steven; Yuan, Yuhong ; Shepherd, Robert; Thomas, Kay; Seitz, Christian; Petřík, Aleš; Türk, Christian; Neisius, Andreas.

In: European Urology, Vol. 76, No. 3, 09.2019, p. 352-367.

Research output: Contribution to journalArticle

Donaldson, James F. ; Ruhayel, Yasir ; Skolarikos, Andreas ; MacLennan, Steven ; Yuan, Yuhong ; Shepherd, Robert ; Thomas, Kay ; Seitz, Christian ; Petřík, Aleš ; Türk, Christian ; Neisius, Andreas. / Treatment of Bladder Stones in Adults and Children : A Systematic Review and Meta-analysis on Behalf of the European Association of Urology Urolithiasis Guideline Panel. In: European Urology. 2019 ; Vol. 76, No. 3. pp. 352-367.
@article{6531fe0874934aaead4d3b16f57b7d2b,
title = "Treatment of Bladder Stones in Adults and Children: A Systematic Review and Meta-analysis on Behalf of the European Association of Urology Urolithiasis Guideline Panel",
abstract = "Context:Bladder stones (BS) constitute 5{\%} of urinary stones. Currently, there is no systematic review on their treatment.Objective:To assess the efficacy (primary outcome: stone-free rate; SFR) and morbidity of BS treatments.Evidence Acquisition:This systematic review was conducted in accordance with the EAU Guidelines Office. Database searches (1970-2019) were screened, abstracted and assessed for risk of bias for comparative RCTs and non-randomized studies (NRS) with ³10 patients per group. Quality of evidence (QoE) was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).Evidence Synthesis:2742 abstracts and 59 full-texts were assessed: 25 studies (2340 patients) were included. In adults, one RCT found a lower SFR following shock wave lithotripsy (SWL) than transurethral cystolithotripsy (TUCL) (RR 0.88, p=0.03; low QoE). Four RCTs compared TUCL vs. percutaneous cystolithotripsy (PCCL): meta-analyses demonstrated no difference in SFR, but hospital stay (mean difference; MD; 0.82days, p<0.00001) and procedure duration (MD 9.83minutes, p<0.00001) favored TUCL (moderate QoE).Four NRS comparing open cystolithotomy (CL) vs. TUCL or PCCL found no difference in SFR; hospital stay and procedure duration favored endoscopic surgery (very low QoE). Four RCTs compared TUCL using a nephroscope vs. cystoscope: meta-analyses demonstrated no difference in SFR; procedure duration favored using a nephroscope (MD 22.74 minutes, p<0.00001; moderate QoE).In children, one NRS showed lower SFR following SWL than TUCL or CL. Two NRS comparing CL vs. TUCL/PCCL found similar SFRs; catheterization time and hospital stay favored endoscopic treatments. One RCT comparing laser vs. pneumatic TUCL found no difference in SFR. One large NRS comparing CL techniques found a shorter hospital stay after tubeless CL in selected cases, QoE was very low.ConclusionCurrent available evidence indicates TUCL is the intervention of choice for BS in adults and children, where feasible. Further high quality research on the topic is required.",
keywords = "Bladder stones, Transurethral cystolithotripsy, Percutaneous cystolithotripsy, Open cystolithotomy, Adults, Children, Stone-free rates, Endoscopic treatments, MANAGEMENT, LITHIASIS, CYSTOLITHOLAPAXY, PERCUTANEOUS SUPRAPUBIC CYSTOLITHOTRIPSY, VESICAL CALCULI, OPEN SURGERY, HOYAG LASER, DIFFERENT ENDOSCOPIC TECHNIQUES, COMPLICATIONS, TRANSURETHRAL RESECTION",
author = "Donaldson, {James F.} and Yasir Ruhayel and Andreas Skolarikos and Steven MacLennan and Yuhong Yuan and Robert Shepherd and Kay Thomas and Christian Seitz and Aleš Petř{\'i}k and Christian T{\"u}rk and Andreas Neisius",
year = "2019",
month = "9",
doi = "10.1016/j.eururo.2019.06.018",
language = "English",
volume = "76",
pages = "352--367",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier",
number = "3",

}

TY - JOUR

T1 - Treatment of Bladder Stones in Adults and Children

T2 - A Systematic Review and Meta-analysis on Behalf of the European Association of Urology Urolithiasis Guideline Panel

AU - Donaldson, James F.

AU - Ruhayel, Yasir

AU - Skolarikos, Andreas

AU - MacLennan, Steven

AU - Yuan, Yuhong

AU - Shepherd, Robert

AU - Thomas, Kay

AU - Seitz, Christian

AU - Petřík, Aleš

AU - Türk, Christian

AU - Neisius, Andreas

PY - 2019/9

Y1 - 2019/9

N2 - Context:Bladder stones (BS) constitute 5% of urinary stones. Currently, there is no systematic review on their treatment.Objective:To assess the efficacy (primary outcome: stone-free rate; SFR) and morbidity of BS treatments.Evidence Acquisition:This systematic review was conducted in accordance with the EAU Guidelines Office. Database searches (1970-2019) were screened, abstracted and assessed for risk of bias for comparative RCTs and non-randomized studies (NRS) with ³10 patients per group. Quality of evidence (QoE) was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).Evidence Synthesis:2742 abstracts and 59 full-texts were assessed: 25 studies (2340 patients) were included. In adults, one RCT found a lower SFR following shock wave lithotripsy (SWL) than transurethral cystolithotripsy (TUCL) (RR 0.88, p=0.03; low QoE). Four RCTs compared TUCL vs. percutaneous cystolithotripsy (PCCL): meta-analyses demonstrated no difference in SFR, but hospital stay (mean difference; MD; 0.82days, p<0.00001) and procedure duration (MD 9.83minutes, p<0.00001) favored TUCL (moderate QoE).Four NRS comparing open cystolithotomy (CL) vs. TUCL or PCCL found no difference in SFR; hospital stay and procedure duration favored endoscopic surgery (very low QoE). Four RCTs compared TUCL using a nephroscope vs. cystoscope: meta-analyses demonstrated no difference in SFR; procedure duration favored using a nephroscope (MD 22.74 minutes, p<0.00001; moderate QoE).In children, one NRS showed lower SFR following SWL than TUCL or CL. Two NRS comparing CL vs. TUCL/PCCL found similar SFRs; catheterization time and hospital stay favored endoscopic treatments. One RCT comparing laser vs. pneumatic TUCL found no difference in SFR. One large NRS comparing CL techniques found a shorter hospital stay after tubeless CL in selected cases, QoE was very low.ConclusionCurrent available evidence indicates TUCL is the intervention of choice for BS in adults and children, where feasible. Further high quality research on the topic is required.

AB - Context:Bladder stones (BS) constitute 5% of urinary stones. Currently, there is no systematic review on their treatment.Objective:To assess the efficacy (primary outcome: stone-free rate; SFR) and morbidity of BS treatments.Evidence Acquisition:This systematic review was conducted in accordance with the EAU Guidelines Office. Database searches (1970-2019) were screened, abstracted and assessed for risk of bias for comparative RCTs and non-randomized studies (NRS) with ³10 patients per group. Quality of evidence (QoE) was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).Evidence Synthesis:2742 abstracts and 59 full-texts were assessed: 25 studies (2340 patients) were included. In adults, one RCT found a lower SFR following shock wave lithotripsy (SWL) than transurethral cystolithotripsy (TUCL) (RR 0.88, p=0.03; low QoE). Four RCTs compared TUCL vs. percutaneous cystolithotripsy (PCCL): meta-analyses demonstrated no difference in SFR, but hospital stay (mean difference; MD; 0.82days, p<0.00001) and procedure duration (MD 9.83minutes, p<0.00001) favored TUCL (moderate QoE).Four NRS comparing open cystolithotomy (CL) vs. TUCL or PCCL found no difference in SFR; hospital stay and procedure duration favored endoscopic surgery (very low QoE). Four RCTs compared TUCL using a nephroscope vs. cystoscope: meta-analyses demonstrated no difference in SFR; procedure duration favored using a nephroscope (MD 22.74 minutes, p<0.00001; moderate QoE).In children, one NRS showed lower SFR following SWL than TUCL or CL. Two NRS comparing CL vs. TUCL/PCCL found similar SFRs; catheterization time and hospital stay favored endoscopic treatments. One RCT comparing laser vs. pneumatic TUCL found no difference in SFR. One large NRS comparing CL techniques found a shorter hospital stay after tubeless CL in selected cases, QoE was very low.ConclusionCurrent available evidence indicates TUCL is the intervention of choice for BS in adults and children, where feasible. Further high quality research on the topic is required.

KW - Bladder stones

KW - Transurethral cystolithotripsy

KW - Percutaneous cystolithotripsy

KW - Open cystolithotomy

KW - Adults

KW - Children

KW - Stone-free rates

KW - Endoscopic treatments

KW - MANAGEMENT

KW - LITHIASIS

KW - CYSTOLITHOLAPAXY

KW - PERCUTANEOUS SUPRAPUBIC CYSTOLITHOTRIPSY

KW - VESICAL CALCULI

KW - OPEN SURGERY

KW - HOYAG LASER

KW - DIFFERENT ENDOSCOPIC TECHNIQUES

KW - COMPLICATIONS

KW - TRANSURETHRAL RESECTION

UR - http://www.scopus.com/inward/record.url?scp=85068858079&partnerID=8YFLogxK

UR - http://www.mendeley.com/research/treatment-bladder-stones-adults-children-systematic-review-metaanalysis-behalf-european-association

U2 - 10.1016/j.eururo.2019.06.018

DO - 10.1016/j.eururo.2019.06.018

M3 - Article

VL - 76

SP - 352

EP - 367

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 3

ER -