📃 Paper Title: Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones
🧍 Author: Attasit Srisubat
🕒 Year: 2014
📚 Journal: Cochrane Database of Systematic Reviews
🌎 Country: Thailand
ㅤContext to the study:
Can you cite a paper comparing the management of renal stones with Extracorporeal Shock-ware Lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS)?
ㅤ✅ Take-home message of study:
ESWL, PCNL, and RIRS are all effective treatments for kidney stones, but the treatment choice should be tailored to the individual patient's needs based on factors such as stone size, location, and preference.
PCNL had a significantly higher success rate regarding stone-free kidneys than ESWL. As for RIRS, it did not differ significantly from ESWL.
PCNL and RIRS are more effective in removing stones for larger stones (> 2 cm) but have higher complication rates than ESWL, while ESWL is associated with fewer complications and a shorter hospital stay but has a lower stone clearance rate for larger stones.
PCNL is not dependent on the stone burden or composition and is indicated for large-volume stones, as RIRS or ESWL could be an alternative in patients with low-volume stones.
ㅤ Systematic review and meta-analysis
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Study participants:
Number included: 338
Inclusion criteria:
Patients with kidney stones treated using ESWL compared with PCNL or RIRS
Exclusion criteria
Pregnant women and children with kidney stones were excluded.
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Key study outcomes:
ESWL vs PCNL
The success of treatment was significantly greater in the PCNL group compared to the ESWL group at 3 months (3 studies, 201 participants; RR 0.46) and one year (2 studies, 107 participants; RR 0.72).
When success was stratified into groups based on initial stone size (namely 1-10mm, 10-22mm and 21-30mm), PCNL group was significantly better in all subgroups.
The success of treatment for lower pole kidney stones (size ≤ 20 mm) was significantly better with PCNL compared to ESWL (2 studies, 155 participants; RR 0.49).
There was a significant increase in auxiliary procedures for lower pole stones in the ESWL group.
Overall Efficiency Quotient (EQ) - ESWL 28% vs 86% PCNL (decreasing for both groups when stone size increased)
Duration of treatment (MD -36 min) and hospital stay (MD -3.3 days) were significantly shorter in the ESWL group.
ESWL vs. RIRS
There was no significant difference in treatment success at three months (1 study, 58 participants; RR 0.91).
Secondary treatments were necessary for 5 ESWL patients and two RIRS patients (1 study, 67 participants; RR 2.73).
The Mean operating time (MD -24,9 min) and hospital stay were significantly longer for RIRS.
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Study Limitations:
A limited number of studies: The review only included five RCTs, which may not provide a comprehensive overview of the available evidence on these treatments.
Four RCTs that compare ESWL vs. PCNL.
Only one RCT that compared ESWL vs. RIRS
Small sample size: Some of the included RCTs had small sample sizes, which may limit the statistical power of the analysis.
Heterogeneity of studies: The included studies used different criteria for patient selection, different types of stones, and different treatment protocols, which may limit the comparability of the results.
Potential publication bias: As with any systematic review, there may be a risk of publication bias, as studies with negative or inconclusive results may be less likely to be published.
Short-term follow-up: The follow-up period in the included studies was relatively short, ranging from 3 to 12 months, which may not provide a complete picture of the long-term effectiveness and safety of the different treatments.
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