Purpose: To compare the efficacy and safety of different treatment options for the management of proximal impacted ureteral stones (PIUS).
Methods: A systematic literature search using Pubmed, Medline, Embase and Cochrane Library was conducted to obtain studies concerning different managements for PIUS up to Jan 2018. Summary odds ratios (ORs), standard mean differences (SMDs) or weighted mean differences with their 95% confidence intervals (CIs) were calculated to compare the efficacy and safety of all included treatment methods, registered in PROSPERO under number CRD42018092745.
Results: A total of 15 comparative studies with 1780 patients were included. Meta-analyses of final stone-free rate (SFR) favored percutaneous nephrolithotomy (PCNL) over ureteroscopic lithotripsy (URL) (OR 10.35; 95% CI 5.26-20.35; P < 0.00001), laparoscopic ureterolithotomy over URL (OR 0.11; 95% CI 0.05-0.25; P < 0.00001) and URL over extracorporeal shockwave lithotripsy (OR 0.47; 95% CI 0.28-0.77; P = 0.003). As to complications, PCNL had a significantly higher blood transfusion rate (OR 7.47; 95% CI 1.3-42.85; P = 0.02) and a lower ureteral injury rate (OR 0.15; 95% CI 0.04-0.52; P = 0.003) compared with URL. It also shared a significantly lower stone-retropulsion rate (OR 0.03; 95% CI 0.01-0.15; P < 0.0001) and higher treatment costs (SMD = 2.71; 95% CI 0.71-4.70; P = 0.008) than URL.
Conclusions: Our meta-analysis suggested that PCNL might be the best option for PIUS owing to its higher successful rate. Complications such as hemorrhage could be decreased by the application on mini-PCNL.
Keywords: Managements; Meta-analysis; Proximal impacted ureteral stones; Systematic review.
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Cited by 1 article
Analysis of the clinical effect and long-term follow-up results of retroperitoneal laparoscopic ureterolithotomy in the treatment of complicated upper ureteral calculi (report of 206 cases followed for 10 years).Int Urol Nephrol. 2019 Nov;51(11):1955-1960. doi: 10.1007/s11255-019-02252-9. Epub 2019 Aug 10. Int Urol Nephrol. 2019. PMID: 31399878
- 2017A030310547/Natural Science Foundation of Guangdong Province
- 2018T110859/China Postdoctoral Science Foundation
- 2017M612636/China Postdoctoral Science Foundation
- 2017M622912/China Postdoctoral Science Foundation
- 81802821/National Natural Science Foundation of China
- 81670643/National Natural Science Foundation of China
- 1201620011/the Collaborative Innovation Project of Guangzhou Education Bureau
- 201604020001/the Guangzhou Science Technology and Innovation Commission
- 201704020193/the Guangzhou Science Technology and Innovation Commission
- 2017B030314108/the Science and Technology Planning Project of Guangdong Province