Τίτλος:
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
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Context: Bladder stones (BS) constitute 5% of urinary stones.
Currently, there is no systematic review of their treatment.
Objective: To assess the efficacy (primary outcome: stone-free rate [
SFR]) and morbidity of BS treatments.
Evidence acquisition: This systematic review was conducted in accordance
with the European Association of Urology Guidelines Office. Database
searches (1970-2019) were screened, abstracted, and assessed for risk of
bias for comparative randomised controlled trials (RCTs) and
nonrandomised studies (NRSs) with >= 10 patients per group. Quality of
evidence (QoE) was assessed using the Grading of Recommendations
Assessment, Development, and Evaluation (GRADE) tool.
Evidence synthesis: A total of 2742 abstracts and 59 full-text articles
were assessed, and 25 studies (2340 patients) were included. In adults,
one RCT found a lower SFR following shock wave lithotripsy (SWL) than
transurethral cystolithotripsy (TUCL; risk ratio 0.88, p = 0.03; low
QoE). Four RCTs compared TUCL versus percutaneous cystolithotripsy
(PCCL): meta-analyses demonstrated no difference in SFR, but hospital
stay (mean difference [MD] 0.82 d, p < 0.00001) and procedure duration
(MD 9.83 min, p < 0.00001) favoured TUCL (moderate QoE). Four NRSs
comparing open cystolithotomy (CL) versus TUCL or PCCL found no
difference in SFR; hospital stay and procedure duration favoured
endoscopic surgery (very low QoE). Four RCTs compared TUCL using a
nephroscope versus a cystoscope: meta-analyses demonstrated no
difference in SFR; procedure duration favoured the use of a nephroscope
(MD 22.74 min, p < 0.00001; moderate QoE). In children, one NRS showed a
lower SFR following SWL than TUCL or CL. Two NRSs comparing CL versus
TUCL/PCCL found similar SFRs; catheterisation time and hospital stay
favoured endoscopic treatments. One RCT comparing laser versus pneumatic
TUCL found no difference in SFR. One large NRS comparing CL techniques
found a shorter hospital stay after tubeless CL in selected cases; QoE
was very low.
Conclusions: Current available evidence indicates that TUCL is the
intervention of choice for BSs in adults and children, where feasible.
Further high-quality research on the topic is required.
Patient summary: We examined the literature to determine the most
effective and least harmful procedures for bladder stones in adults and
children. The results suggest that endoscopic surgery is equally
effective as open surgery. It is unclear whether stone size affects
outcomes. Shock wave lithotripsy appears to be less effective.
Endoscopic treatments appear to have shorter catheterisation time and
convalescence compared with open surgery in adults and children.
Transurethral surgery, where feasible, appears to have a shorter
hospital stay than percutaneous surgery. Further research is required to
clarify the efficacy of minimally invasive treatments for larger stones
and in young children. (C) 2019 European Association of Urology.
Published by Elsevier B.V. All rights reserved.
Συγγραφείς:
Donaldson, James F.
Ruhayel, Yasir
Skolarikos, Andreas and
MacLennan, Steven
Yuan, Yuhong
Shepherd, Robert
Thomas, Kay
and Seitz, Christian
Petrik, Ales
Turk, Christian
Neisius,
Andreas
Περιοδικό:
European urology oncology
Λέξεις-κλειδιά:
Bladder stones; Transurethral cystolithotripsy; Percutaneous
cystolithotripsy; Open cystolithotomy; Adults; Children; Stone-free
rates; Endoscopic treatments
DOI:
10.1016/j.eururo.2019.06.018
