Does the presence or degree of hydronephrosis affect the stone disintegration efficacy of extracorporeal shock wave lith
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ORIGINAL PAPER
Does the presence or degree of hydronephrosis affect the stone disintegration efficacy of extracorporeal shock wave lithotripsy? A systematic review and meta‑analysis Zihao He1,2,3 · Shanfeng Yin1,2,3 · Xiaolu Duan1,2,3 · Guohua Zeng1,2,3 Received: 25 July 2019 / Accepted: 30 September 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract The aim of this study was to determine whether the presence or degree of hydronephrosis (HN) affects the stone disintegration efficacy of shock wave lithotripsy (SWL). A comprehensive literature search using PubMed, Embase, Cochrane Library, and Web of Science was conducted to retrieve relevant studies. Risk ratios (RRs) and mean differences (MDs) with corresponding 95% confidence intervals (CIs) were calculated for comparisons of outcomes of interest. In total, seven comparative studies with 2033 patients were included. Overall results indicated no significant difference in stone-free rate (SFR) and retreatment rate between two groups. Subgroup analysis further revealed: (1) compared with moderate or severe HN, non-HN SWL brought significantly lower retreatment rate (RR 0.67, 95%CI 0.52–0.87, P = 0.002 and RR 0.55, 95%CI: 0.40–0.76, P = 0.0003, respectively) and shorter clearance time (MD − 3.80, 95%CI − 5.81 to − 1.79, P = 0.0002 and MD – 5.93, 95%CI − 10.29 to − 1.57, P = 0.008, respectively); (2) SWLs performed without stone-induced HN or with artificial HN were associated with significantly higher SFR (RR 1.11, 95%CI 1.04−1.18, P = 0.001 and RR 0.93, 95%CI 0.87−0.99, P = 0.02, respectively); (3) non-HN SWL brought significantly higher SFR than HN group when treating proximal ureteral stones (RR 1.14, 95%CI 1.04–1.24, P = 0.005). Generally, SWLs performed with HN were shown to offer similar stone disintegration efficacy to those without HN. However, it seemed preferable to perform SWL: (1) without severe to moderate HN or stone-induced HN; (2) with artificial HN; (3) without HN when treating proximal ureteral stones. Keywords Shock wave lithotripsy · SWL · Hydronephrosis · Meta-analysis · Systematic review
Introduction Due to its noninvasiveness and established efficacy, extracorporeal shock wave lithotripsy (SWL) has been recommended as a first-line treatment for upper urinary tract stones 50%), or the random-effect model (DerSimonian–Laird method) [21] was used (P
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