Holmium laser lithotripsy versus pneumatic lithotripsy for treatment of distal ureteral calculi:a meta-analysis / 中国组织工程研究

ABSTRACT

BACKGROUND:Pneumatic lithotripsy and holmium laser lithotripsy for distal ureteral calculi have their own advantages and disadvantages in efficacy and complications, but both of them are currently better treatments. ＜br> OBJECTIVE:To compare the efficacy and safety of holmium laser lithotripsy and pneumatic lithotripsy for the treatment of distal ureteral calculi through a meta analysis. ＜br> METHODS:A online search of China Biological Medicine disk, PubMed, Cochrane Library, Springerlink, Medline, and Embase databases was performed from March 1999 to December 2013. A manual retrieval of relevant journals was also done for clinical trials about holmium laser lithotripsy and pneumatic lithotripsy for treatment of distal ureteral calculi. RevMan 5.1.5 software (Cachrane Library) was used for meta analysis. The fol owing indexes were used to compare the results:mean operative time, early stone free rate, stone migration rate, ureteral perforation rate, postoperative hematuria rate and retaining double-J catheter rate. ＜br> RESULTS AND CONCLUSION:Four prospective studies (a total of 275 patients) were enrol ed, and there were 140 cases in the group of holmium laser lithotripsy and 133 cases in the pneumatic Lithotripsy group. Holmium laser lithotripsy conveyed significant benefits compared with pneumatic lithotripsy in mean operative time [WMD=-16.38, 95%CI (-20.29,-12.47), P＜0.000 01], stone migration incidence [OR=0.25, 95%CI (0.10, 0.63), P=0.003], retaining double-J catheter rate [OR=0.44, 95%CI (0.25, 0.78), P=0.004], while early stone free rate, postoperative hematuria rate and ureteral perforation rate had no significant changes between the two groups. Compared with pneumatic lithotripsy, holmium laser lithotripsy can shorten mean operative time and reduce the stone migration rate. Because of the lack of prospective studies and smal sample size, large-sized randomized control ed studies are urgently needed to provide evidence.