PMID- 25381743
OWN - NLM
STAT- MEDLINE
DCOM- 20151016
LR  - 20181202
IS  - 1464-410X (Electronic)
IS  - 1464-4096 (Linking)
VI  - 116
IP  - 2
DP  - 2015 Aug
TI  - Comparative effectiveness and safety of various treatment procedures for lower 
      pole renal calculi: a systematic review and network meta-analysis.
PG  - 252-64
LID - 10.1111/bju.12983 [doi]
AB  - 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.
CI  - (c) 2014 The Authors BJU International (c) 2014 BJU International Published by John 
      Wiley & Sons Ltd.
FAU - Lee, Shaun Wen-Huey
AU  - Lee SW
AD  - School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.
FAU - Chaiyakunapruk, Nathorn
AU  - Chaiyakunapruk N
AD  - School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.
AD  - School of Population Health, University of Queensland, Brisbane, Qld, Australia.
AD  - Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy 
      Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, 
      Thailand.
AD  - School of Pharmacy, University of Wisconsin, Madison, WI, USA.
FAU - Chong, Huey-Yi
AU  - Chong HY
AD  - School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.
FAU - Liong, Men-Long
AU  - Liong ML
AD  - Department of Urology, Island Hospital, Penang, Malaysia.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20150317
PL  - England
TA  - BJU Int
JT  - BJU international
JID - 100886721
SB  - IM
MH  - Adult
MH  - Female
MH  - Humans
MH  - Kidney Calculi/*surgery
MH  - *Lithotripsy/adverse effects/methods/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - *Nephrostomy, Percutaneous/adverse effects/methods/statistics & numerical data
MH  - Treatment Outcome
MH  - *Ureteroscopy/adverse effects/methods/statistics & numerical data
MH  - Young Adult
OTO - NOTNLM
OT  - lithotripsy
OT  - lower pole kidney calculi
OT  - lower pole renal calculi
OT  - percutaneous nephrolithotomy
OT  - ureterorenoscopy
EDAT- 2014/11/11 06:00
MHDA- 2015/10/17 06:00
CRDT- 2014/11/11 06:00
PHST- 2014/11/11 06:00 [entrez]
PHST- 2014/11/11 06:00 [pubmed]
PHST- 2015/10/17 06:00 [medline]
AID - 10.1111/bju.12983 [doi]
PST - ppublish
SO  - BJU Int. 2015 Aug;116(2):252-64. doi: 10.1111/bju.12983. Epub 2015 Mar 17.