Ultrasound versus fluoroscopy-guided extracorporeal shockwave lithotripsy in renal calculi: a systematic review and meta-analysis.

IF 2 2区 医学 Q2 UROLOGY & NEPHROLOGY
Mohammed Ramadhan, Arthur Braga, Mohammad Alzaid, Tarek Benzouak, Fadl Hamouche, Ahmad Almarzouq
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Abstract

Extracorporeal shockwave lithotripsy (ESWL) is one of the first-line treatments in the management of renal stones and is usually performed using fluoroscopic (FS) guidance. Ultrasonography (US) is a potential alternative with minimal radiation exposure. The primary aim of this study was to compare the stone free rate (SFR) between US and FS guided ESWL. The secondary outcomes were overall complications, re-intervention rate, hematuria, UTI, pain occurrence and number of shocks required. A prospectively registered systematic review and meta-analysis (CRD42024511335) according to PRISMA guidelines, was conducted. MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, were searched up to February 15, 2024. Snowballing techniques and Google Scholar were used for external gray literature. Adult and pediatric subgroups were pooled and individually analyzed. Twelve studies were identified with 2673 patients. Ultrasonography yielded a significantly favorable SFR (OR 1.43;95%CI [1.06-1.94]; P = 0.02). This difference was found only in the adult subgroup. No differences were found between modalities, nor within any subgroup in terms of secondary outcomes. In this meta-analysis, US-ESWL demonstrated a higher SFR compared to standard FS-ESWL However, this finding was shown only in adult patients, and although there was no difference in pediatric patients, the minimized radiation exposure remains an attractive attribute in US-ESWL.These results should be interpreted cautiously, due to a limited number of RCTs and heterogeneity between studies. More research is needed especially in pediatric populations, to further elucidate the role of US in ESWL.

超声与透视引导下体外冲击波碎石治疗肾结石:系统回顾和荟萃分析。
体外冲击波碎石术(ESWL)是治疗肾结石的一线治疗方法之一,通常在透视镜(FS)指导下进行。超声检查(US)是一种潜在的替代方法,具有最小的辐射暴露。本研究的主要目的是比较US和FS引导下ESWL的结石游离率(SFR)。次要结果为总并发症、再干预率、血尿、尿路感染、疼痛发生率和所需电击次数。根据PRISMA指南进行前瞻性注册系统评价和荟萃分析(CRD42024511335)。MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science,检索截止到2024年2月15日。外部灰色文献采用滚雪球法和谷歌Scholar。将成人和儿童亚组汇总并单独分析。12项研究纳入2673例患者。超声检查显示明显有利的SFR (OR 1.43;95%CI [1.06-1.94];p = 0.02)。这种差异只在成人亚组中发现。两种治疗方式之间没有发现差异,在任何亚组中也没有发现次要结局方面的差异。在这项荟萃分析中,US-ESWL与标准FS-ESWL相比显示出更高的SFR。然而,这一发现仅在成人患者中出现,尽管在儿科患者中没有差异,但US-ESWL的最小辐射暴露仍然是一个有吸引力的属性。由于随机对照试验的数量有限以及研究之间的异质性,这些结果应谨慎解释。需要更多的研究,特别是在儿科人群中,进一步阐明US在ESWL中的作用。
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来源期刊
Urolithiasis
Urolithiasis UROLOGY & NEPHROLOGY-
CiteScore
4.50
自引率
6.50%
发文量
74
期刊介绍: Official Journal of the International Urolithiasis Society The journal aims to publish original articles in the fields of clinical and experimental investigation only within the sphere of urolithiasis and its related areas of research. The journal covers all aspects of urolithiasis research including the diagnosis, epidemiology, pathogenesis, genetics, clinical biochemistry, open and non-invasive surgical intervention, nephrological investigation, chemistry and prophylaxis of the disorder. The Editor welcomes contributions on topics of interest to urologists, nephrologists, radiologists, clinical biochemists, epidemiologists, nutritionists, basic scientists and nurses working in that field. Contributions may be submitted as full-length articles or as rapid communications in the form of Letters to the Editor. Articles should be original and should contain important new findings from carefully conducted studies designed to produce statistically significant data. Please note that we no longer publish articles classified as Case Reports. Editorials and review articles may be published by invitation from the Editorial Board. All submissions are peer-reviewed. Through an electronic system for the submission and review of manuscripts, the Editor and Associate Editors aim to make publication accessible as quickly as possible to a large number of readers throughout the world.
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