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Treatment of bladder stones in adults and children: A systematic review and meta-analysis on behalf of the European Association of Urology Urolithiasis Guideline Panel

European Urology Jul 20, 2019

Donaldson JF, et al. - A systematic review in accordance with the European Association of Urology Guidelines Office was carried out by the researchers to evaluate the effectiveness (primary outcome - stone-free rate [SFR]) and morbidity of bladder stone (BS) treatments. A total of 2,742 abstracts and 59 full-text articles were evaluated, and 25 studies (n=2,340) were involved. A lower SFR post-shock wave lithotripsy (SWL) than transurethral cystolithotripsy (TUCL) was ascertained in one randomized controlled trial (RCT). Four RCTs contrasted TUCL vs percutaneous cystolithotripsy (PCCL) and meta-analyses exhibited no variation in SFR, however, hospital stay and procedure span favored TUCL. Four nonrandomized studies (NRSs) when compared open cystolithotomy (CL) to TUCL or PCCL, obtained no variation in SFR, while hospital stay and procedure duration favored endoscopic surgery (very low quality of evidence {QoE}). Four RCTs compared TUCL using a nephroscope to a cystoscope and meta-analyses could not exhibit any difference in SFR, however, the procedure span favored the use of a nephroscope. One NRS explicated a lower SFR after SWL in comparison with TUCL or CL, in children. Two NRSs comparing CL vs TUCL/PCCL found similar SFRs and catheterization time and hospital stay favored endoscopic treatments. One RCT comparing laser to pneumatic TUCL could not discover any variation in SFR. One large NRS that compared CL techniques discovered a shorter hospital stay following tubeless CL in selected cases with a very low QoE. Hence, TUCL was concluded as the intervention of choice for BSs in adults and children, where possible. Further high-quality study on the topic is needed.
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