Category: Clinical Stones: Outcomes

MP31-15 - Comparison of stone-free rates following shock wave lithotripsy, percutaneous nephrolithotomy, and retrograde intrarenal surgery for treatment of renal stones: A systematic review and network meta-analysis

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective :

The European Association of Urology Urolithiasis Guidelines suggest that the primary treatment of renal stones 2 cm should include percutaneous nephrolithotomy (PCNL). Therefore, we performed a systematic review and a network meta-analysis analysis that compares the success as well as the stone-free rates of SWL, RIRS, and PCNL.


Methods :

Previously reported studies comparing RIRS, SWL, and PCNL for treatment of renal stones were identified from electronic databases. Stone-free rates for the procedures were compared by qualitative and quantitative syntheses (meta-analyses). Outcome variables are shown as risk ratios (ORs) with 95% confidence intervals (CIs).


Results :

A total of 24 studies were included in this network meta-analysis of success and stone-free rates following three different treatments of renal stones. Six studies compared PCNL versus SWL, six studies compared PCNL versus RIRS, eight studies compared RIRS versus SWL, and four studies compared PCNL, SWL, and RIRS. The quality scores within subscales were relatively low risk. Network meta-analyses indicated that the stone-free rates of RIRS (OR 0.36; 95% CI 0.19–0.68) and SWL (0.12; 95% CI 0.065–0.22) were lower than that of PCNL. In addition, the stone-free rate of SWL was lower than that of RIRS (OR 0.34; 95% CI 0.19–0.58) (Fig 1). In the rank-probability test, PCNL was ranked as No. 1 and SWL was ranked as No. 3 (Fig 2).


Conclusions :

PCNL for renal stones resulted in the highest success and stone-free rate and ranked the highest of the treatments analyzed. In contrast, SWL ranked the lowest of the treatments because of its lowest success and stone-free rates. The complexity of individual patients considered in this network meta-analysis may have played a role in the results. Future analyses should include patient selection criteria such as renal stone location.

Kang Su Cho

Associate Professor
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
Seoul, Seoul-t'ukpyolsi, Republic of Korea

Associate Professor, Department of Urology

Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

DO Kyung Kim

Jongchan Kim

Fellow
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
Seoul, Seoul-t'ukpyolsi, Republic of Korea

Jongchan Kim, MD, fellow, Yonsei university Severance hospital

2003.03~2009.02 Yonsei university, college of medicine
2009.03~2010.02 Interen at Severance hospital
2010.03~2014.02 Resident at department of Urology, Severance hospital
2014.05~2017.04 Flight surgeon at Aerospace medical center
2017.05~ Fellow at Severance hospital

Hae Do Jung

Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
Seoul, Seoul-t'ukpyolsi, Republic of Korea

Kang Su Cho

Associate Professor
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
Seoul, Seoul-t'ukpyolsi, Republic of Korea

Associate Professor, Department of Urology

Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

Young Deuk Choi

Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
Seoul, Seoul-t'ukpyolsi, Republic of Korea

Joo Yong Lee

Clinical Assistant Professor
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
Seoul, Seoul-t'ukpyolsi, Republic of Korea

Joo Yong Lee, M.D., Ph.D.
Clinical Assistant Professor

Department of Urology, Severance Hospital,
Urological Science Institute, Yonsei University College of Medicine,
50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea

Tel. +82-2-2228-2320 / Fax. +82-2-312-2538 / Mobile. +82-10-6537-9779
E-mail. joouro@yuhs.ac / joouro@gmail.com