Clinical Efficacy, Safety, and Costs of Percutaneous Occlusive Balloon Catheter-Assisted Ureteroscopic Lithotripsy for Large Impacted Proximal Ureteral Calculi: A Prospective, Randomized Study

Qi, Shiyong; Li, Yanni; Liu, Xu; Zhang, Chang-wen; Zhang, Hongtuan; Xu, Yong

doi:10.1089/end.2014.0167

Cited by 11 publications

(23 citation statements)

References 30 publications

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“…Fig 1 shows the procedure of literature search and study selection. The studies consisted of five RCTs [ 12 – 16 ], one prospective [ 19 ] and four retrospective cohort studies [ 17 , 18 , 20 , 21 ]. Basic characteristics, such as age, sex ratio, stone size and stone side, were described comparable between rigid URSL and PCNL group in each study and the data was presented in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Fig 2A showed that all of the RCTs described suggested randomization. Three studies [ 12 , 13 , 16 ] failed to report details about allocation concealment. It was quite difficult to perform blinding of participants or personnel in surgical treatment, so a high risk of bias was judged in this part for each study.…”

Section: Resultsmentioning

confidence: 99%

“…So there comes a question for urologists that which one is better for patients with large proximal ureteral stones. Since 1999, several studies comparing the efficacy and safety of rigid URSL and PCNL in treating large proximal ureteral stones have been carried out [ 12 – 21 ]. As the results of these studies are not totally consistent, a meta-analysis which compares the outcomes of rigid URSL and PCNL should be carried out to provide some advice for urologists and patients in making relevant decisions in the future.…”

Section: Introductionmentioning

confidence: 99%

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Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis

Wang

Guo

et al. 2017

PLoS ONE

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ObjectTo compare the safety and efficacy of rigid ureteroscopic lithotripsy (rigid URSL) and percutaneous nephrolithotomy (PCNL) in treating large proximal ureteral stones.MethodsA systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science databases was performed to find out relevant studies. After literature screening according to the predetermined inclusion and exclusion criteria, data of eligible studies was extracted and then a meta-analysis was conducted via RevMan 5.3 software.ResultsFive randomized controlled trials (RCTs), one prospective and four retrospective cohort studies involving 837 patients were included. Patients underwent rigid URSL were associated with shorter operation time (WMD, -23.66min; 95%CI, −45.00 to -2.32; p = 0.03), shorter hospital stay (WMD, -2.76d; 95%CI, −3.51 to −2.02; p< 0.00001), lower 3rd-day (RR, 0.73; 95%CI, 0.66 to 0.82; p < 0.00001) and 1st-month (RR, 0.82; 95%CI, 0.77 to 0.87; p < 0.00001) stone-free rate, higher risk of conversion to other surgical procedures (RR, 4.28; 95%CI, 1.93 to 9.46; p = 0.0003), higher incidence of migration (RR, 28.49; 95%CI, 9.12 to 89.00; p < 0.00001) and ureteral perforation (RR, 6.06; 95%CI, 1.80 to 20.44; p = 0.004), lower risk of fever (RR, 0.64; 95%CI, 0.42 to 0.97; p = 0.04), transfusion (RR, 0.19; 95%CI, 0.04 to 0.85; p = 0.03) and hematuria (RR, 0.38; 95%CI, 0.25 to 0.57; p < 0.0001). No significant difference was observed in terms of incidence of embolization, pain and ureterostenosis. When cohort studies or studies in which flexible ureteroscopy was used as an intraoperative auxiliary procedure were excluded, we both found that most of the results kept stable.ConclusionsBoth PCNL and rigid URSL are safe for patients with large proximal ureteral stones while PCNL is more effective in stone clearance.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis

Wang

Guo

et al. 2017

PLoS ONE

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“…The prevalence of migration for impacted stones was much higher with much lower SFRs compared to migrated non-impacted stones. It could be that patients with impacted stone were more likely to have hydronephrosis or a higher degree of hydronephrosis resulting in a higher intra-operative migration rate [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of ureteroscopic treatment in 2650 patients with impacted ureteral stones

et al. 2017

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PurposeTo describe stone-free rates and complications of ureteroscopic treatment for impacted compared with non-impacted ureteral stones and evaluate predictive variables for impaction.MethodsThe Clinical Research Office of the Endourological Society prospectively collected 1 consecutive year of data from 114 centers worldwide. Patients eligible for inclusion were patients treated with ureteroscopy for ureteral stones. Patient characteristics, treatment details, and outcomes were compared with regard to stone impaction. Logistic regression analyses were conducted to explore predictive variables for ureteral stone impaction and to analyse the effect of impaction on outcomes.ResultsOf the 8543 treated patients, 2650 (31%) had impacted and 5893 (69%) non-impacted stones. The stone-free rate was 87.1% for impacted stones, which is lower compared with 92.7% for non-impacted stones (p < 0.001). Intra-operative complication rates were higher for impacted stones (7.9 versus 3.0%, p < 0.001). Significantly higher ureteral perforation- and avulsion rates were reported in the impacted stone group compared with the non-impacted stone group. No association between stone impaction and post-operative complications could be shown. Female gender, ASA-score >1, prior stone treatment, positive pre-operative urine culture, and larger stones showed to be predictive variables for stone impaction.ConclusionsUreteroscopic treatment for impacted stones is associated with lower stone-free rates and higher intra-operative complication rates compared with treatment for non-impacted stones. The predictive variables for the presence of stone impaction may contribute to the identification of stone impaction during the diagnostic process. Moreover, identification of stone impaction may aid the selection of the optimal treatment modality.Electronic supplementary materialThe online version of this article (doi:10.1007/s00345-017-2028-2) contains supplementary material, which is available to authorized users.

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“…I then examined the original results of the works I mentioned above. It was reported that 20 patients who underwent URS need flexible ureteroscopy in the postoperative period, and none of the patients with PCNL required an auxilliary procedure in the study of Qi et al [2]. The data in meta-analysis belong to patients who do not need auxilliary procedure.…”

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confidence: 99%

Letter to the editor

Özman

2020

World J Urol

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Clinical Efficacy, Safety, and Costs of Percutaneous Occlusive Balloon Catheter-Assisted Ureteroscopic Lithotripsy for Large Impacted Proximal Ureteral Calculi: A Prospective, Randomized Study

Abstract: For large impacted proximal ureteral calculi, POBC-URSL was associated with a higher stone clearance rate, fewer complications and costs. POBC-URSL combined the advantages of URSL and PNL.

Cited by 11 publications

References 30 publications

Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis

Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis

Characteristics and outcomes of ureteroscopic treatment in 2650 patients with impacted ureteral stones

Letter to the editor

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