ABSTRACT
INTRODUCTION: The highest in quality data in the literature which compared mini percutaneous nephrolithotripsy (mPCNL), retrograde intrarenal surgery (RIRS) and shock wave lithotripsy (SWL) for the management of lower pole stone (LPS) with a maximal diameter ≤20 mm were investigated by means of systematic review (SR) and meta-analysis. EVIDENCE ACQUISITION: A SR of the literature was conducted on PubMed, Cochrane, SCOPUS and EMBASE in January 2020. The study complied with the PRISMA statement and recommendations of the EAU Guidelines office. Only randomized controlled trials (RCTs) comparing retrograde intrarenal surgery (RIRS), shock wave lithotripsy (SWL) and mini-percutaneous nephrolithotripsy (mPCNL) were selected for the meta-analysis. The endpoints were the efficacy of each modality, measured by stone-free rate (SFR), operative time and retreatment rate and the safety of each method, based on hospitalization time and complications. Subgroup analyses for stones with a maximal diameter <10 mm and 10-20 mm were performed. EVIDENCE SYNTHESIS: Twenty-one RCTs were included in the meta-analysis. mPCNL had the highest SFR and the lowest retreatment rate among the three modalities, while SWL had the lowest SFR and the highest retreatment rate. The operative and hospitalization time were shorter in the case of SWL, whereas they were similar in the case of mPCNL and RIRS. The highest complication rate was observed in mPCNL group, which accounted for 8.3-22.4%, while RIRS and SWL had similar complication rates, which ranged between 1.3-31.4% and 0-48.5%, respectively. Further classification of the complications according to Clavien-Dindo system revealed that SWL had lower grade II complication rates compared to mPCNL and RIRS. Regarding stones <10 mm, SWL and RIRS had similar SFR, complication rate, operation and hospitalization time. SWL had higher retreatment rate. CONCLUSIONS: For LPSs ≤20 mm, mPCNL provides the highest SFR and the lowest retreatment rate. This modality has a higher complication rate and longer hospital stay in comparison to the other modalities. SWL provides the lowest SFR with the highest retreatment rate. RIRS has similar complication rate to SWL and could be preferred over SWL. For stones up to 10 mm, SWL may provide a valid alternative. Despite a higher retreatment rate, its SFR is similar to RIRS.
Subject(s)
Kidney Calculi , Lithotripsy , Nephrolithotomy, Percutaneous , Humans , Kidney Calculi/surgery , Lithotripsy/adverse effects , Nephrolithotomy, Percutaneous/adverse effects , Technology , UrologistsABSTRACT
OBJECTIVE: To compare the retropulsion of stones with the use of holmium: yttrium aluminum garnet (Ho: YAG) laser and thulium: yttrium aluminum garnet (Tm: YAG) laser in settings that could be used in clinical practice. METHODS: The experimental configuration included a glass tube set in a water bath filled with physiologic saline. Plaster of Paris stones were inserted in the tube. Tm: YAG and Ho: YAG laser systems were used along with a high-speed slow-motion camera. The lasers were activated with different settings. The displacement of the stone was measured according to a custom-made algorithm. RESULTS: Ho: YAG: the retropulsion of stones was the lowest with the energy setting of 0.5 J and the frequency of 20 Hz with long pulse duration. The highest retropulsion was observed in the case of 3 J, 5 Hz, and short pulse. Tm: YAG: the retropulsion of stones was the lowest with the energy setting of 1 J and the frequency of 10 Hz with either long or short pulse duration. Practically, there was no retropulsion at all. The highest retropulsion was observed in the case of 8 J, 5 Hz, and short pulse. CONCLUSION: Ho: YAG laser has a linear increase in stone retropulsion with increased pulse energy. On the other hand, the retropulsion rate was kept to the minimum with Tm: YAG as much as the energy level of 8 J. The activation of lasers with short pulse resulted in further displacement of the stone. Lower frequency with the same power setting seemed to result in further stone retropulsion. Higher power with the same frequency setting resulted in further displacement of the stone.
