Energy output modalities of shockwave lithotripsy in the treatment of urinary stones: escalating or fixed voltage? A sys
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INVITED REVIEW
Energy output modalities of shockwave lithotripsy in the treatment of urinary stones: escalating or fixed voltage? A systematic review and meta‑analysis Zihao He1,2,3 · Tuo Deng1,2,3 · Shanfeng Yin1,2,3 · Zihao Xu1,2,3 · Haifeng Duan1,2,3 · Yeda Chen1,2,3 · Xiaolu Duan1,2,3 · Guohua Zeng1,2,3 Received: 2 February 2019 / Accepted: 3 December 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Purpose To compare the effectiveness and safety of escalating and fixed energy output modalities of shockwave lithotripsy (SWL) in the treatment of urinary stones. Methods A systematic literature search using PubMed, Embase, Cochrane Library and Web of Science was performed to obtain relevant studies up to December 2018. Summarized mean differences (MDs) and risk differences (RDs) with 95% confidence intervals (CIs) were used for comparing continuous and dichotomous variables, respectively. Results Six RCTs including 775 patients were identified. In the overall pooled outcomes, no significant difference was detected between escalating and fixed voltage group regarding initial and final success rate (SR) and stone-free status (SFS), auxiliary procedure and complication (hematoma, febrile episode, and pain) rate. However, when shockwave frequency ≥ 90 shocks/min, total shocks per session ≤ 3000, or 1–3 SWL sessions were performed, escalating group was associated with significantly higher SR1 (defined as SFS + fragments ≤ 4 mm); in addition, escalating group brought significantly less hematoma when total shocks per session ≤ 3000. Conclusions Escalating voltage SWL offered comparable safety and effectiveness to that of fixed voltage SWL. However, escalating voltage SWL could be recommended in following conditions: (1) shockwave frequency ≥ 90 shocks/min, total shocks per session ≤ 3000, or 1–3 SWL sessions, for better stone removal; (2) total shocks per session ≤ 3000, for less hematoma formation. Keywords Shockwave lithotripsy · Energy output modality · Urinary stone · Meta-analysis
Zihao He and Tuo Deng authors are contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-019-03049-2) contains supplementary material, which is available to authorized users. * Guohua Zeng [email protected] 1
Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1#, Haizhu District, Guangzhou 510230, Guangdong, China
2
Guangzhou Institute of Urology, Guangzhou, China
3
Guangdong Key Laboratory of Urology, Guangzhou, China
Abbreviations MD Mean difference RD Risk difference CI Confidence interval RCT Randomized controlled trial ESWL Extracorporeal shock wave lithotripsy SWL Shock wave lithotripsy SR Success rate SFS Stone-free status PCNL Percutaneous nephrolithotomy UPJ Ureteropelvic junction
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Introduction Since the introduction of extracorporeal shockwave lithotripsy (ESWL) into clinical pra
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