What are the Benefits and Harms of Ureteroscopy Compared with Shock-wave Lithotripsy in the Treatment of Upper Ureteral Stones?

A Systematic Review

Tamsin Drake, Nikolaos Grivas, Saeed Dabestani, Thomas Knoll, Thomas Lam, Steven Maclennan, Ales Petrik, Andreas Skolarikos, Michael Straub, Christian Tuerk, Cathy Yuhong Yuan, Kemal Sarica

Research output: Contribution to journalArticle

19 Citations (Scopus)
20 Downloads (Pure)

Abstract

Context
Extracorporeal shock wave lithotripsy (SWL) and ureteroscopy (URS), with or without intracorporeal lithotripsy, are the most common treatments for upper ureteric stones. With advances in technology, it is unclear which treatment is most effective and/or safest.

Objective
To systematically review literature reporting benefits and harms of SWL and URS in the management of upper ureteric stones.

Evidence acquisition
Databases including Medline, Embase, and the Cochrane library were searched from January 2000 to November 2014. All randomised controlled trials (RCTs), quasi-randomised controlled trials, and nonrandomised studies comparing any subtype or variation of URS and SWL were included. The primary benefit outcome was stone-free rate (SFR). The primary harm outcome was complications. Secondary outcomes included retreatment rate, need for secondary, and/or adjunctive procedures. The Cochrane risk of bias tool was used to assess RCTs, and an extended version was used to assess nonrandomised studies. Grading of Recommendations Assessment, Development, and Evaluation was used to assess the quality of evidence.

Evidence synthesis
Five thousand-three hundred and eighty abstracts and 387 full-text articles were screened. Forty-seven studies met inclusion criteria; 19 (39.6%) were RCTs. No studies on children met inclusion criteria. URS and SWL were compared in 22 studies (4 RCTs, 1 quasi-randomised controlled trial, and 17 nonrandomised studies). Meta-analyses were inappropriate due to data heterogeneity. SFR favoured URS in 9/22 studies. Retreatment rates were higher for SWL compared with URS in all studies but one. Longer hospital stay and adjunctive procedures (most commonly the insertion of a JJ stent) were more common when primary treatment was URS. Complications were reported in 11 out of 22 studies. In eight studies, it was possible to report this as a Clavien-Dindo Grade. Higher complication rates across all grades were reported for URS compared with SWL. For intragroup (intra-SWL and intra-URS) comparative studies, 25 met the inclusion criteria. These studies varied greatly in outcomes measured with data being heterogeneous.

Conclusions
Compared with SWL, URS was associated with a significantly greater SFR up to 4 wk but the difference was not significant at 3 mo in the included studies. URS was associated with fewer retreatments and need for secondary procedures, but with a higher need for adjunctive procedures, greater complication rates, and longer hospital stay.

Patient summary
In this paper, the relative benefits and harms of the two most commonly offered treatment options for urinary stones located in the upper ureter were reviewed. We found that both treatments are safe and effective options that should be offered based on individual patient circumstances and preferences.
Original languageEnglish
Pages (from-to)772-786
Number of pages15
JournalEuropean Urology
Volume72
Issue number5
Early online date26 Apr 2017
DOIs
Publication statusPublished - Nov 2017

Fingerprint

Ureteroscopy
Lithotripsy
Shock
Randomized Controlled Trials
Retreatment
Therapeutics
Length of Stay
Urinary Calculi
Patient Preference
Ureter
Libraries
Stents
Meta-Analysis

Keywords

  • Shock wave lithotripsy
  • Ureteroscopy
  • Ureteral calculi
  • Urolithiasis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

What are the Benefits and Harms of Ureteroscopy Compared with Shock-wave Lithotripsy in the Treatment of Upper Ureteral Stones? A Systematic Review. / Drake, Tamsin; Grivas, Nikolaos; Dabestani, Saeed; Knoll, Thomas; Lam, Thomas; Maclennan, Steven; Petrik, Ales; Skolarikos, Andreas; Straub, Michael; Tuerk, Christian; Yuan, Cathy Yuhong; Sarica, Kemal.

In: European Urology, Vol. 72, No. 5, 11.2017, p. 772-786.

Research output: Contribution to journalArticle

Drake, T, Grivas, N, Dabestani, S, Knoll, T, Lam, T, Maclennan, S, Petrik, A, Skolarikos, A, Straub, M, Tuerk, C, Yuan, CY & Sarica, K 2017, 'What are the Benefits and Harms of Ureteroscopy Compared with Shock-wave Lithotripsy in the Treatment of Upper Ureteral Stones? A Systematic Review', European Urology, vol. 72, no. 5, pp. 772-786. https://doi.org/10.1016/j.eururo.2017.04.016
Drake, Tamsin ; Grivas, Nikolaos ; Dabestani, Saeed ; Knoll, Thomas ; Lam, Thomas ; Maclennan, Steven ; Petrik, Ales ; Skolarikos, Andreas ; Straub, Michael ; Tuerk, Christian ; Yuan, Cathy Yuhong ; Sarica, Kemal. / What are the Benefits and Harms of Ureteroscopy Compared with Shock-wave Lithotripsy in the Treatment of Upper Ureteral Stones? A Systematic Review. In: European Urology. 2017 ; Vol. 72, No. 5. pp. 772-786.
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abstract = "ContextExtracorporeal shock wave lithotripsy (SWL) and ureteroscopy (URS), with or without intracorporeal lithotripsy, are the most common treatments for upper ureteric stones. With advances in technology, it is unclear which treatment is most effective and/or safest.ObjectiveTo systematically review literature reporting benefits and harms of SWL and URS in the management of upper ureteric stones.Evidence acquisitionDatabases including Medline, Embase, and the Cochrane library were searched from January 2000 to November 2014. All randomised controlled trials (RCTs), quasi-randomised controlled trials, and nonrandomised studies comparing any subtype or variation of URS and SWL were included. The primary benefit outcome was stone-free rate (SFR). The primary harm outcome was complications. Secondary outcomes included retreatment rate, need for secondary, and/or adjunctive procedures. The Cochrane risk of bias tool was used to assess RCTs, and an extended version was used to assess nonrandomised studies. Grading of Recommendations Assessment, Development, and Evaluation was used to assess the quality of evidence.Evidence synthesisFive thousand-three hundred and eighty abstracts and 387 full-text articles were screened. Forty-seven studies met inclusion criteria; 19 (39.6{\%}) were RCTs. No studies on children met inclusion criteria. URS and SWL were compared in 22 studies (4 RCTs, 1 quasi-randomised controlled trial, and 17 nonrandomised studies). Meta-analyses were inappropriate due to data heterogeneity. SFR favoured URS in 9/22 studies. Retreatment rates were higher for SWL compared with URS in all studies but one. Longer hospital stay and adjunctive procedures (most commonly the insertion of a JJ stent) were more common when primary treatment was URS. Complications were reported in 11 out of 22 studies. In eight studies, it was possible to report this as a Clavien-Dindo Grade. Higher complication rates across all grades were reported for URS compared with SWL. For intragroup (intra-SWL and intra-URS) comparative studies, 25 met the inclusion criteria. These studies varied greatly in outcomes measured with data being heterogeneous.ConclusionsCompared with SWL, URS was associated with a significantly greater SFR up to 4 wk but the difference was not significant at 3 mo in the included studies. URS was associated with fewer retreatments and need for secondary procedures, but with a higher need for adjunctive procedures, greater complication rates, and longer hospital stay.Patient summaryIn this paper, the relative benefits and harms of the two most commonly offered treatment options for urinary stones located in the upper ureter were reviewed. We found that both treatments are safe and effective options that should be offered based on individual patient circumstances and preferences.",
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TY - JOUR

T1 - What are the Benefits and Harms of Ureteroscopy Compared with Shock-wave Lithotripsy in the Treatment of Upper Ureteral Stones?

T2 - A Systematic Review

AU - Drake, Tamsin

AU - Grivas, Nikolaos

AU - Dabestani, Saeed

AU - Knoll, Thomas

AU - Lam, Thomas

AU - Maclennan, Steven

AU - Petrik, Ales

AU - Skolarikos, Andreas

AU - Straub, Michael

AU - Tuerk, Christian

AU - Yuan, Cathy Yuhong

AU - Sarica, Kemal

N1 - Funding/Support and role of the sponsor: None.

PY - 2017/11

Y1 - 2017/11

N2 - ContextExtracorporeal shock wave lithotripsy (SWL) and ureteroscopy (URS), with or without intracorporeal lithotripsy, are the most common treatments for upper ureteric stones. With advances in technology, it is unclear which treatment is most effective and/or safest.ObjectiveTo systematically review literature reporting benefits and harms of SWL and URS in the management of upper ureteric stones.Evidence acquisitionDatabases including Medline, Embase, and the Cochrane library were searched from January 2000 to November 2014. All randomised controlled trials (RCTs), quasi-randomised controlled trials, and nonrandomised studies comparing any subtype or variation of URS and SWL were included. The primary benefit outcome was stone-free rate (SFR). The primary harm outcome was complications. Secondary outcomes included retreatment rate, need for secondary, and/or adjunctive procedures. The Cochrane risk of bias tool was used to assess RCTs, and an extended version was used to assess nonrandomised studies. Grading of Recommendations Assessment, Development, and Evaluation was used to assess the quality of evidence.Evidence synthesisFive thousand-three hundred and eighty abstracts and 387 full-text articles were screened. Forty-seven studies met inclusion criteria; 19 (39.6%) were RCTs. No studies on children met inclusion criteria. URS and SWL were compared in 22 studies (4 RCTs, 1 quasi-randomised controlled trial, and 17 nonrandomised studies). Meta-analyses were inappropriate due to data heterogeneity. SFR favoured URS in 9/22 studies. Retreatment rates were higher for SWL compared with URS in all studies but one. Longer hospital stay and adjunctive procedures (most commonly the insertion of a JJ stent) were more common when primary treatment was URS. Complications were reported in 11 out of 22 studies. In eight studies, it was possible to report this as a Clavien-Dindo Grade. Higher complication rates across all grades were reported for URS compared with SWL. For intragroup (intra-SWL and intra-URS) comparative studies, 25 met the inclusion criteria. These studies varied greatly in outcomes measured with data being heterogeneous.ConclusionsCompared with SWL, URS was associated with a significantly greater SFR up to 4 wk but the difference was not significant at 3 mo in the included studies. URS was associated with fewer retreatments and need for secondary procedures, but with a higher need for adjunctive procedures, greater complication rates, and longer hospital stay.Patient summaryIn this paper, the relative benefits and harms of the two most commonly offered treatment options for urinary stones located in the upper ureter were reviewed. We found that both treatments are safe and effective options that should be offered based on individual patient circumstances and preferences.

AB - ContextExtracorporeal shock wave lithotripsy (SWL) and ureteroscopy (URS), with or without intracorporeal lithotripsy, are the most common treatments for upper ureteric stones. With advances in technology, it is unclear which treatment is most effective and/or safest.ObjectiveTo systematically review literature reporting benefits and harms of SWL and URS in the management of upper ureteric stones.Evidence acquisitionDatabases including Medline, Embase, and the Cochrane library were searched from January 2000 to November 2014. All randomised controlled trials (RCTs), quasi-randomised controlled trials, and nonrandomised studies comparing any subtype or variation of URS and SWL were included. The primary benefit outcome was stone-free rate (SFR). The primary harm outcome was complications. Secondary outcomes included retreatment rate, need for secondary, and/or adjunctive procedures. The Cochrane risk of bias tool was used to assess RCTs, and an extended version was used to assess nonrandomised studies. Grading of Recommendations Assessment, Development, and Evaluation was used to assess the quality of evidence.Evidence synthesisFive thousand-three hundred and eighty abstracts and 387 full-text articles were screened. Forty-seven studies met inclusion criteria; 19 (39.6%) were RCTs. No studies on children met inclusion criteria. URS and SWL were compared in 22 studies (4 RCTs, 1 quasi-randomised controlled trial, and 17 nonrandomised studies). Meta-analyses were inappropriate due to data heterogeneity. SFR favoured URS in 9/22 studies. Retreatment rates were higher for SWL compared with URS in all studies but one. Longer hospital stay and adjunctive procedures (most commonly the insertion of a JJ stent) were more common when primary treatment was URS. Complications were reported in 11 out of 22 studies. In eight studies, it was possible to report this as a Clavien-Dindo Grade. Higher complication rates across all grades were reported for URS compared with SWL. For intragroup (intra-SWL and intra-URS) comparative studies, 25 met the inclusion criteria. These studies varied greatly in outcomes measured with data being heterogeneous.ConclusionsCompared with SWL, URS was associated with a significantly greater SFR up to 4 wk but the difference was not significant at 3 mo in the included studies. URS was associated with fewer retreatments and need for secondary procedures, but with a higher need for adjunctive procedures, greater complication rates, and longer hospital stay.Patient summaryIn this paper, the relative benefits and harms of the two most commonly offered treatment options for urinary stones located in the upper ureter were reviewed. We found that both treatments are safe and effective options that should be offered based on individual patient circumstances and preferences.

KW - Shock wave lithotripsy

KW - Ureteroscopy

KW - Ureteral calculi

KW - Urolithiasis

U2 - 10.1016/j.eururo.2017.04.016

DO - 10.1016/j.eururo.2017.04.016

M3 - Article

VL - 72

SP - 772

EP - 786

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 5

ER -