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Does the presence or degree of hydronephrosis affect the stone disintegration efficacy of extracorporeal shock wave lithotripsy? A systematic review and meta-analysis

  • Zihao He
  • Shanfeng Yin
  • Xiaolu Duan
  • Guohua ZengEmail author
Original Paper


The aim of this study was to determine whether the presence or degree of hydronephrosis (HN) affects the stone disintegration efficacy of shock wave lithotripsy (SWL). A comprehensive literature search using PubMed, Embase, Cochrane Library, and Web of Science was conducted to retrieve relevant studies. Risk ratios (RRs) and mean differences (MDs) with corresponding 95% confidence intervals (CIs) were calculated for comparisons of outcomes of interest. In total, seven comparative studies with 2033 patients were included. Overall results indicated no significant difference in stone-free rate (SFR) and retreatment rate between two groups. Subgroup analysis further revealed: (1) compared with moderate or severe HN, non-HN SWL brought significantly lower retreatment rate (RR 0.67, 95%CI 0.52–0.87, P = 0.002 and RR 0.55, 95%CI: 0.40–0.76, P = 0.0003, respectively) and shorter clearance time (MD − 3.80, 95%CI − 5.81 to − 1.79, P = 0.0002 and MD – 5.93, 95%CI − 10.29 to − 1.57, P = 0.008, respectively); (2) SWLs performed without stone-induced HN or with artificial HN were associated with significantly higher SFR (RR 1.11, 95%CI 1.04−1.18, P = 0.001 and RR 0.93, 95%CI 0.87−0.99, P = 0.02, respectively); (3) non-HN SWL brought significantly higher SFR than HN group when treating proximal ureteral stones (RR 1.14, 95%CI 1.04–1.24, P = 0.005). Generally, SWLs performed with HN were shown to offer similar stone disintegration efficacy to those without HN. However, it seemed preferable to perform SWL: (1) without severe to moderate HN or stone-induced HN; (2) with artificial HN; (3) without HN when treating proximal ureteral stones.


Shock wave lithotripsy SWL Hydronephrosis Meta-analysis Systematic review 



This work was financed by the Guangdong provincial Science and Technology Plan Project, China (No. 2017B030314108).

Author contributions

ZH involved in project development, data collection, data analysis, manuscript writing; SY took part in data collection and data analysis; XD participated in manuscript editing; GZ took part in project development and manuscript editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

No ethical concerns.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Zihao He
    • 1
    • 2
    • 3
  • Shanfeng Yin
    • 1
    • 2
    • 3
  • Xiaolu Duan
    • 1
    • 2
    • 3
  • Guohua Zeng
    • 1
    • 2
    • 3
    Email author
  1. 1.Department of Urology, Minimally Invasive Surgery CenterThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
  2. 2.Guangzhou Institute of UrologyGuangzhouChina
  3. 3.Guangdong Key Laboratory of UrologyGuangzhouChina

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