Comparative effectiveness and safety of various treatment procedures for lower pole renal calculi: a systematic review and network meta-analysis

Lee, Shuan Wen-Huey, Chaiyakunapruk, Nathorn, Chong, Huey-Yi and Liong, Men-Long (2015) Comparative effectiveness and safety of various treatment procedures for lower pole renal calculi: a systematic review and network meta-analysis. BJU International, 116 2: 252-264. doi:10.1111/bju.12983


Author Lee, Shuan Wen-Huey
Chaiyakunapruk, Nathorn
Chong, Huey-Yi
Liong, Men-Long
Title Comparative effectiveness and safety of various treatment procedures for lower pole renal calculi: a systematic review and network meta-analysis
Journal name BJU International   Check publisher's open access policy
ISSN 1464-410X
1464-4096
Publication date 2015-08-01
Year available 2015
Sub-type Article (original research)
DOI 10.1111/bju.12983
Open Access Status Not Open Access
Volume 116
Issue 2
Start page 252
End page 264
Total pages 13
Place of publication Chichester, West Sussex United Kingdom
Publisher Wiley-Blackwell Publishing
Collection year 2016
Language eng
Formatted abstract
Objective
To compare the effectiveness of various treatments used for lower pole renal calculi.

Methods
We searched PubMed, EMBASE, CINAHL, the Cochrane Collaboration's Database of Systematic Reviews, the Cochrane Collaboration Central Register of Controlled Clinical Trials as well as ClinicalTrials.gov for reports up to 1 April 2014. The search was supplemented with abstract reports from various urology conferences. All randomised, ‘blinded’ clinical studies including patients treated for lower pole renal calculi of <20 mm were included for review. Two authors independently reviewed 5 194 articles, and identified and selected 13 trials for analysis. Network meta-analysis was performed to generate comparative statistics, while quality was assessed with the Jadad composite scale and risk of bias.

Results
All treatment methods examined: percutaneous nephrolithotomy (PNL), ureterorenoscopy (URS) and extracorporeal shockwave lithotripsy (SWL) with an adjuvant therapy (such as inversion, hydration and forced diuresis) were more effective than SWL therapy alone, with risk ratios (95% confidence intervals) of being stone free of: PNL 2.19 (1.62–2.96); URS 1.23 (1.03–1.48); and SWL with an adjuvant therapy 1.30 (1.03–1.63). However, patients treated with the other treatment methods also had a higher risk of adverse events (AEs) compared with SWL, but there was no evidence of a convincing difference between the various techniques and AEs.

Conclusion
In stones of <10 mm, SWL with an adjuvant therapy appears to have better stone clearance, lower risk of AEs, and need for further treatment. PNL was most effective treating larger stones, after considering both effectiveness and safety of treatment. These should be considered by both physicians and patients alike when considering the choice of treatment and in the revision of clinical practice guidelines.
Keyword Lower pole kidney calculi
Lithotripsy
Ureterorenoscopy
Percutaneous nephrolithotomy
Lower pole renal calculi
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Public Health Publications
 
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