PMID- 29686172
OWN - NLM
STAT- MEDLINE
DCOM- 20180918
LR  - 20180918
IS  - 0125-9326 (Print)
IS  - 0125-9326 (Linking)
VI  - 50
IP  - 1
DP  - 2018 Jan
TI  - Meta-analysis of Optimal Management of Lower Pole Stone of 10 - 20 mm: Flexible 
      Ureteroscopy (FURS) versus Extracorporeal Shock Wave Lithotripsy (ESWL) versus 
      Percutaneus Nephrolithotomy (PCNL).
PG  - 18-25
AB  - BACKGROUND: the optimal management of lower calyceal stones is still 
      controversial, because no single method is suitable for the removal of all lower 
      calyceal stones. Minimally invasive procedures such as extracorporeal shock wave 
      lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and flexible ureteroscopy 
      (fURS) are the therapeutic methods for lower calyceal stones. The aim of this 
      study was to identify the optimal management of 10-20 mm lower pole stones. 
      METHODS: a meta-analysis of cohort studies published before July 2016 was 
      performed from Medline and Cochrane databases. Management of 10-20 mm lower pole 
      stone treated by fURS, ESWL and PCNL with follow-up of residual stones in 1-3 
      months after procedure were include and urinary stone in other location and size 
      were excluded. A fixed-effects model with Mantzel-Haenzel method was used to 
      calculate the pooled Risk Ratio (RRs) and 95% Confidence Interval (CIs). We 
      assessed the heterogeneity by calculating the I2 statistic. All analyses were 
      performed with Review manager 5.3. RESULTS: we analized 8 cohort studies. The 
      stone free rate from 958 patients (271 PCNL, 174 fURS and 513 ESWL), 3 months 
      after operation, was 90.8% (246/271) after PCNL; 75.3% (131/174) after fURS; and 
      64.7% (332/513) after ESWL. Base on stone free rate in 10-20 mm lower pole stone 
      following management, PCNL is better than fURS (overall RR was 1.32 (95% CI 1.13 
      - 1.55); p<0.001 and I2=57%) and ESWL (overall risk ratio 1.42 (95% CI 1.30 - 
      1.55); p=<0.001 and I2 = 85%). But, if we compare between fURS and ESWL, fURS is 
      better than ESWL base on stone free rate in 10-20 mm lower pole stone management 
      with overall RR 1.16 (95% CI 1.04 - 1.30; p=0.01 and I2=40%). CONCLUSION: 
      percutaneus nephrolithotomy provided a higher stone free rate than fURS and ESWL. 
      This meta-analysis may help urologist in making decision of intervention in 10-20 
      mm lower pole stone management.
FAU - Yuri, Prahara
AU  - Yuri P
AD  - Division of Urology, Department of Surgery, Faculty of Medicine Universitas 
      Gadjah Mada - Sardjito Hospital, Yogyakarta, Indonesia. prahara.yuri@yahoo.com.
FAU - Hariwibowo, Rinto
AU  - Hariwibowo R
FAU - Soeroharjo, Indrawarman
AU  - Soeroharjo I
FAU - Danarto, Raden
AU  - Danarto R
FAU - Hendri, Ahmad Z
AU  - Hendri AZ
FAU - Brodjonegoro, Sakti R
AU  - Brodjonegoro SR
FAU - Rasyid, Nur
AU  - Rasyid N
FAU - Birowo, Ponco
AU  - Birowo P
FAU - Widyahening, Indah S
AU  - Widyahening IS
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PL  - Indonesia
TA  - Acta Med Indones
JT  - Acta medica Indonesiana
JID - 7901042
SB  - IM
MH  - Humans
MH  - Kidney Calculi/*therapy
MH  - *Lithotripsy
MH  - *Nephrolithotomy, Percutaneous
MH  - Randomized Controlled Trials as Topic
MH  - Treatment Outcome
MH  - *Ureteroscopy
OTO - NOTNLM
OT  - extracorporeal shock wave lithotripsy
OT  - flexible ureteroscopy
OT  - lower pole stone
OT  - percutaneus nephrolithotomy
EDAT- 2018/04/25 06:00
MHDA- 2018/09/19 06:00
CRDT- 2018/04/25 06:00
PHST- 2018/04/25 06:00 [entrez]
PHST- 2018/04/25 06:00 [pubmed]
PHST- 2018/09/19 06:00 [medline]
PST - ppublish
SO  - Acta Med Indones. 2018 Jan;50(1):18-25.