A comparison between ureteroscopic lithotripsy and extracorporeal shockwave lithotripsy in urolithiasis

Abstract

Topic Overview: Urolithiasis is a highly prevalent urological condition amongst the Maltese population. Multiple patients requiring medical treatment or surgical interventions for urolithiasis are admitted yearly in Mater Dei Hospital. The purpose of this literature review is to compare ureteroscopic lithotripsy and extracorporeal shockwave lithotripsy in order to determine which procedure is more effective in clearing ureteric calculi. Research Question: In adults undergoing treatment for urolithiasis, is ureteroscopic lithotripsy more effective than extracorporeal shockwave lithotripsy in ureteric stone clearance rates? PICO Elements: The population (P) of this study were adult participants presented with ureteric calculi. The intervention (I) included patients undergoing ureteroscopic lithotripsy. The comparison (C) composed of patients undergoing extracorporeal shockwave lithotripsy. The outcome (O) measured was stone clearance rates. Methods: Numerous databases and meta-search engines were utilised to acquire relevant studies in relation to the proposed research question. The inclusion criteria for selecting relevant studies consisted of studies written in English, published within the last ten years and measuring the outcomes of URSL and ESWL on adult patients with urolithiasis. A total of five key- studies which sufficed the eligibility criteria were retrieved and analysed. The five selected studies in this review composed of two systematic reviews, two meta-analyses and one randomised controlled trial. The studies’ methodological rigour were all appraised with the CASP tool. Results: A total of 6,916 patients were included, 3,468 received ESWL while the remaining 3,448 underwent URSL. The findings of the sole RCT concluded that URSL and ESWL have similar stonefree rates (SFRs), therefore no statistically significant difference was recorded between the two treatment modalities. However, the results of the systematic reviews and the meta-analyses indicate and conclude that there is indeed a statistically significant difference in SFRs among the procedures. Conclusions: Ureteroscopic Lithotripsy is the more effective in ureteric stone clearance when compared with Extracorporeal Shockwave Lithotripsy as it achieves immediate and complete stone clearance.