Effectiveness and Safety of Ureteroscopy Surgery in Treatment of Upper Ureteral Calculi: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 LIHan ¹ ,  WANGKun-jie ² , HUXing-ping ¹

1. Department of Urology, Fifth Chengdu People's Hospital, Chengdu 611130, China;
2. Department of Urology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding?author：

WANGKun-jie, Email: wzwzlwww@qq.com

Keywords：

Upper ureteral calculi; Transurethral ureteroscopy lithotripsy; Etroperitoneal laparoscopic ureterolithotomy; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140182

Video：

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Objective To systematically review the effectiveness and safety of transurethral ureteroscopy lithotripsy in the treatment of upper ureteral calculi. Methods We electronically searched The Cochrane Library (Issue 3, 2013), PubMed (1966 to 2013.8), EMbase (1990 to 2013.8), CNKI (1949 to 2013.9), CBM (1978 to 2013.9), VIP (1989 to 2013.8) and WanFang Data (1990 to 2013.8) for the randomized controlled studies (RCTs) related to retroperitoneoscopy ureterolithotomy versus transurethral ureteroscopy lithotripsy for upper ureteral calculi. Two reviewers independently screened literature, extracted data, and evaluated methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software. Results A total of 16 RCTs involving 1 410 patients (transurethral ureteroscopy lithotripsy:747 cases; etroperitoneal laparoscopic ureterolithotomy:663 cases) were included. The results of meta-analysis showed that, transurethral ureteroscopy lithotripsy was lower than retroperitoneoscopy ureterolithotomy in success rates of surgery (OR=0.26, 95%CI 0.14 to 0.51), 3-day stone clearance rates (OR=0.06, 95%CI 0.03 to 0.11), and 1-month stone clearance rates (OR=0.21, 95%CI 0.08 to 0.53), while it showed superiority in operation time (MD=-22.35, 95%CI-35.29 to-9.41) and postoperative hospital stay (MD=-1.84, 95%CI-3.44 to-0.24). Conclusion Current evidence shows that, in the treatment of upper ureteral calculi, transurethral ureteroscopy lithotripsy causes less operation time and postoperative hospital stay, but it had no advantage in success rates of surgery, 3-day stone clearance rates, and 1-month stone clearance rates.

Citation： LIHan, WANGKun-jie, HUXing-ping. Effectiveness and Safety of Ureteroscopy Surgery in Treatment of Upper Ureteral Calculi: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(9): 1119-1125. doi: 10.7507/1672-2531.20140182 Copy

1.	那彥群, 主編.中國泌尿外科疾病診斷治療指南. 2009版.北京:人民衛生出版社, 2009:166-199.
2.	Khaladkar S, Modi J, Bhansali M, et al. Which is the best option to treat large (>1.5 cm) midureteric calculi?. J Laparoendosc Adv Surg Tech A, 2009, 19(4):501-504.
3.	劉鳴, 主編.系統評價、META-分析設計與實驗方法.第1版.北京:人民衛生出版社, 2011:98-117.
4.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
5.	張翼飛, 梁朝朝, 郝宗耀, 等.兩種方法治療輸尿管上段結石的比較.安徽醫學, 2013, 34(2):124-126.
6.	鄧孫林, 王忠.三種微刨術式治療嵌頓性輸尿管上段結石的療效比較.臨床醫學工程, 2014, 19(4):535-537.
7.	郭輝權, 劉冠.上段輸尿管結石三種微創治療方法的對比分析.當代醫學, 2012, 18(12):65-66.
8.	楊東.后腹腔鏡與輸尿管鏡治療輸尿管結石的臨床對比分析.臨床研究, 2012, 10(36):466-467.
9.	金江江, 翁責茗, 張建球.后腹腔鏡輸尿管切開取石術與經尿道輸尿管鏡碎石術治療復雜性輸尿管上段結石的療效觀察.中國基層醫藥, 2013, 20(15):2368-2370.
10.	李海平, 楊艷穎, 韓子華, 等.后腹腔鏡輸尿管切開取石術與經尿道輸尿管鏡碎石術治療輸尿管上段結石的療效比較.中國基層醫藥, 2010, 17(13):1826-1827.
11.	湯慶峰, 王紹勇, 洪戰鋒.腹膜后腹腔鏡與輸尿管鏡治療輸尿管上段嵌頓性結石的對比研究.腹腔鏡外科雜志, 2010, 15(11):864-865.
12.	馬大富.腹膜后腹腔鏡和輸尿管鏡治療上輸尿管結石療效對比.臨床醫學, 2012, 32(2):62-63.
13.	王昌兵, 梁朝朝, 顧恒, 等.輸尿管上段復雜結石的3種微創治療比較.安徽醫科大學學報, 2011, 46(7):724-725.
14.	任知良, 張大萌, 鞠俊玉.輸尿管鏡下與腹腔鏡下治療輸尿管結石比較.浙江臨床醫學, 2011, 2(13):154-155.
15.	劉暉.輸尿管鏡與后腹腔鏡手術治療輸尿管上段結石療效比較.白求恩軍醫學院學報, 2007, 5(4):217-218.
16.	方友強, 邱劍光, 吳杰英, 等.輸尿管鏡與后腹腔鏡手術治療輸尿管上段結石的療效比較.中華腔鏡泌尿外科雜志(電子版), 2012, 6(2):24-27.
17.	敖勁松, 汪波, 邱承俊, 等.輸尿管鏡與后腹腔鏡手術治療輸尿管上段結石的療效比較.中華腔鏡泌尿外科雜志(電子版), 2013, 7(4):289-291.
18.	Fang YQ, Qiu JG, Wang DJ, et al. Comparative study on ureteroscopic lithotripsy and laparoscopic ureterolithotomy for treatment of unilateral upper ureteral stones. Acta Cir Bras, 2012, 27(3):1678-1684.
19.	Abbas B, Nasser S, Amirmohsen Z, et al. Retrograde, Antegrade, and Laparoscopic Approaches for the Management of Large, Proximal Ureteral Stones:A Randomized Clinical Trial. J Endourology, 2008, 22(12):2677-2680.
20.	Wang YY, Hou JQ, Wen DG, et al. Comparative analysis of upper ureteral stones(>15 mm) treated with retroperitoneoscopic ureterolithotomy and ureteroscopic pneumatic lithotripsy. Int Urol Nephrol, 2010, 42(19):897-901.
21.	Leonardo C, Simone G, Rocco P, et al. Laparoscopic ureterolithotomy:minimally invasive second line treatment. Int Urol Nephrol, 2011, 43(3):651-654.
22.	Farooq SJ, Khan N, Khan M. Retroperitoneal laparoscopic ureterolithotomy-a single centre 10 year experience. Int J Surg, 2011, 9(2):160-164.
23.	Flasko T, Holman E, Kovacs G, et al. Laparoscopic ureterolithotomy:the method of choice in selected cases. J Laparoendosc Adv Surg Tech A, 2005, 15(2):149-152.

1. 那彥群, 主編.中國泌尿外科疾病診斷治療指南. 2009版.北京:人民衛生出版社, 2009:166-199.
2. Khaladkar S, Modi J, Bhansali M, et al. Which is the best option to treat large (>1.5 cm) midureteric calculi?. J Laparoendosc Adv Surg Tech A, 2009, 19(4):501-504.
3. 劉鳴, 主編.系統評價、META-分析設計與實驗方法.第1版.北京:人民衛生出版社, 2011:98-117.
4. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
5. 張翼飛, 梁朝朝, 郝宗耀, 等.兩種方法治療輸尿管上段結石的比較.安徽醫學, 2013, 34(2):124-126.
6. 鄧孫林, 王忠.三種微刨術式治療嵌頓性輸尿管上段結石的療效比較.臨床醫學工程, 2014, 19(4):535-537.
7. 郭輝權, 劉冠.上段輸尿管結石三種微創治療方法的對比分析.當代醫學, 2012, 18(12):65-66.
8. 楊東.后腹腔鏡與輸尿管鏡治療輸尿管結石的臨床對比分析.臨床研究, 2012, 10(36):466-467.
9. 金江江, 翁責茗, 張建球.后腹腔鏡輸尿管切開取石術與經尿道輸尿管鏡碎石術治療復雜性輸尿管上段結石的療效觀察.中國基層醫藥, 2013, 20(15):2368-2370.
10. 李海平, 楊艷穎, 韓子華, 等.后腹腔鏡輸尿管切開取石術與經尿道輸尿管鏡碎石術治療輸尿管上段結石的療效比較.中國基層醫藥, 2010, 17(13):1826-1827.
11. 湯慶峰, 王紹勇, 洪戰鋒.腹膜后腹腔鏡與輸尿管鏡治療輸尿管上段嵌頓性結石的對比研究.腹腔鏡外科雜志, 2010, 15(11):864-865.
12. 馬大富.腹膜后腹腔鏡和輸尿管鏡治療上輸尿管結石療效對比.臨床醫學, 2012, 32(2):62-63.
13. 王昌兵, 梁朝朝, 顧恒, 等.輸尿管上段復雜結石的3種微創治療比較.安徽醫科大學學報, 2011, 46(7):724-725.
14. 任知良, 張大萌, 鞠俊玉.輸尿管鏡下與腹腔鏡下治療輸尿管結石比較.浙江臨床醫學, 2011, 2(13):154-155.
15. 劉暉.輸尿管鏡與后腹腔鏡手術治療輸尿管上段結石療效比較.白求恩軍醫學院學報, 2007, 5(4):217-218.
16. 方友強, 邱劍光, 吳杰英, 等.輸尿管鏡與后腹腔鏡手術治療輸尿管上段結石的療效比較.中華腔鏡泌尿外科雜志(電子版), 2012, 6(2):24-27.
17. 敖勁松, 汪波, 邱承俊, 等.輸尿管鏡與后腹腔鏡手術治療輸尿管上段結石的療效比較.中華腔鏡泌尿外科雜志(電子版), 2013, 7(4):289-291.
18. Fang YQ, Qiu JG, Wang DJ, et al. Comparative study on ureteroscopic lithotripsy and laparoscopic ureterolithotomy for treatment of unilateral upper ureteral stones. Acta Cir Bras, 2012, 27(3):1678-1684.
19. Abbas B, Nasser S, Amirmohsen Z, et al. Retrograde, Antegrade, and Laparoscopic Approaches for the Management of Large, Proximal Ureteral Stones:A Randomized Clinical Trial. J Endourology, 2008, 22(12):2677-2680.
20. Wang YY, Hou JQ, Wen DG, et al. Comparative analysis of upper ureteral stones(>15 mm) treated with retroperitoneoscopic ureterolithotomy and ureteroscopic pneumatic lithotripsy. Int Urol Nephrol, 2010, 42(19):897-901.
21. Leonardo C, Simone G, Rocco P, et al. Laparoscopic ureterolithotomy:minimally invasive second line treatment. Int Urol Nephrol, 2011, 43(3):651-654.
22. Farooq SJ, Khan N, Khan M. Retroperitoneal laparoscopic ureterolithotomy-a single centre 10 year experience. Int J Surg, 2011, 9(2):160-164.
23. Flasko T, Holman E, Kovacs G, et al. Laparoscopic ureterolithotomy:the method of choice in selected cases. J Laparoendosc Adv Surg Tech A, 2005, 15(2):149-152.

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of Ureteroscopy Surgery in Treatment of Upper Ureteral Calculi: A Meta-Analysis

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