Systematic review and cumulative analysis of the managements for proximal impacted ureteral stones
To compare the efficacy and safety of different treatment options for the management of proximal impacted ureteral stones (PIUS).
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.
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.
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.
KeywordsProximal impacted ureteral stones Managements Systematic review Meta-analysis
This study was financed by Grants from the Natural Science Foundation of Guangdong Province (No. 2017A030310547), China Postdoctoral Science Foundation (No. 2018T110859, No. 2017M612636 and No. 2017M622912), National Natural Science Foundation of China (No. 81802821 and No. 81670643), the Collaborative Innovation Project of Guangzhou Education Bureau (No. 1201620011) the Guangzhou Science Technology and Innovation Commission (No. 201604020001 and No. 201704020193), and the Science and Technology Planning Project of Guangdong Province (No. 2017B030314108).
TD: project development, data collection, data analysis, and manuscript writing; YC: data collection, data analysis, and manuscript writing; BL: data collection, data analysis, and manuscript writing; MPL: manuscript editing; JJMCHdlR: manuscript editing; XD: manuscript editing; WW: manuscript editing; GZ: project development and manuscript editing.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
No ethical approval was necessary due to its exclusive use of secondary data.
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