Arran Dingwall, James Leighton, Angus Luk, Mark Chambers, Bhaskar Somani, Robert Geraghty
{"title":"输尿管镜和激光碎石术治疗小于2厘米的下段结石,原位与移位?系统回顾和荟萃分析","authors":"Arran Dingwall, James Leighton, Angus Luk, Mark Chambers, Bhaskar Somani, Robert Geraghty","doi":"10.1111/bju.16534","DOIUrl":null,"url":null,"abstract":"<div>\n \n <section>\n \n <h3> Objective</h3>\n \n <p>To investigate the outcomes of ureteroscopy and lasertripsy in lower pole renal stones <2 cm when treated <i>in situ</i> compared to displacement to the upper pole.</p>\n </section>\n \n <section>\n \n <h3> Patients and Methods</h3>\n \n <p>Using the Medical Literature Analysis and Retrieval System Online (MEDLINE)/PubMed, the Excerpta Medica dataBASE (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, and Clinicaltrials.gov we identified adult population, English language, studies published until March 2023 comparing surgical outcomes and stone-free rates (SFRs) in relation to lower pole stones <2 cm managed <i>in situ</i> vs those displaced (International Prospective Register of Systematic Reviews [PROSPERO] identifier: CRD42023432750). Analysis was performed using R with the ‘meta’ package. Bias analysis was performed using the Cochrane Risk of Bias 2 tool for randomised trials and the Newcastle–Ottawa scale for observational studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to ascertain the certainty of evidence.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of five studies were included, comprising two retrospective cohort studies, three randomised trials, with a total of 408 patients. Meta-analysis demonstrated SFRs are significantly higher in those patients undergoing displacement vs those managed <i>in situ</i> (risk ratio 1.21, 95% confidence interval [CI] 1.10–1.34, <i>P</i> < 0.001). There was no significant difference in complication rates. Operative time was significantly longer in the displacement group (mean difference 5.62 min, 95% CI 0.40–10.83 min; <i>P</i> = 0.03). Overall risk of bias was moderate. Certainty of evidence was moderate for stone-free status, and very low for all other outcomes.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>This systematic review and meta-analysis demonstrates that for lower pole stones <2 cm displacement strategies have significantly higher SFRs than treatment <i>in situ</i>, with no significant difference in complications. There is significantly increased operative time in the displaced group, but an additional 6 min is unlikely to be clinically significant.</p>\n </section>\n </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"135 3","pages":"399-407"},"PeriodicalIF":4.4000,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bju.16534","citationCount":"0","resultStr":"{\"title\":\"Ureteroscopy and lasertripsy for lower pole stones <2 cm, in situ vs displacement? 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Ureteroscopy and lasertripsy for lower pole stones <2 cm, in situ vs displacement? A systematic review and meta-analysis
Objective
To investigate the outcomes of ureteroscopy and lasertripsy in lower pole renal stones <2 cm when treated in situ compared to displacement to the upper pole.
Patients and Methods
Using the Medical Literature Analysis and Retrieval System Online (MEDLINE)/PubMed, the Excerpta Medica dataBASE (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, and Clinicaltrials.gov we identified adult population, English language, studies published until March 2023 comparing surgical outcomes and stone-free rates (SFRs) in relation to lower pole stones <2 cm managed in situ vs those displaced (International Prospective Register of Systematic Reviews [PROSPERO] identifier: CRD42023432750). Analysis was performed using R with the ‘meta’ package. Bias analysis was performed using the Cochrane Risk of Bias 2 tool for randomised trials and the Newcastle–Ottawa scale for observational studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to ascertain the certainty of evidence.
Results
A total of five studies were included, comprising two retrospective cohort studies, three randomised trials, with a total of 408 patients. Meta-analysis demonstrated SFRs are significantly higher in those patients undergoing displacement vs those managed in situ (risk ratio 1.21, 95% confidence interval [CI] 1.10–1.34, P < 0.001). There was no significant difference in complication rates. Operative time was significantly longer in the displacement group (mean difference 5.62 min, 95% CI 0.40–10.83 min; P = 0.03). Overall risk of bias was moderate. Certainty of evidence was moderate for stone-free status, and very low for all other outcomes.
Conclusions
This systematic review and meta-analysis demonstrates that for lower pole stones <2 cm displacement strategies have significantly higher SFRs than treatment in situ, with no significant difference in complications. There is significantly increased operative time in the displaced group, but an additional 6 min is unlikely to be clinically significant.
期刊介绍:
BJUI is one of the most highly respected medical journals in the world, with a truly international range of published papers and appeal. Every issue gives invaluable practical information in the form of original articles, reviews, comments, surgical education articles, and translational science articles in the field of urology. BJUI employs topical sections, and is in full colour, making it easier to browse or search for something specific.