Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral...Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral stones.Methods We retrospectively reviewed 734 patients with ureteral stones treated by fluoroscopy-guided shockwave lithotripsy between March 2014 and March 2021.The primary outcome was a stone-free rate with one session within 30 days,defined as no residual stones without auxiliary treatment.The multivariate analysis was used to examine whether the intravenous urography use predicted treatment success.Furthermore,we compared the outcomes using propensity score matching.Results Ninety-eight patients underwent the intravenous urography use protocol(Group I),and the remaining 636 patients underwent the non-intravenous urography protocol(Group N).Stone-free rates with one session within 30 days were 38%and 32%in groups I and N,respectively(p=0.3).No statistical differences were observed in the conversion rate to ureteroscopy(p=0.3)or complication rate(p=0.7)between Group I and Group N.One patient who developed skin redness was considered a complication of the contrast medium.Propensity score matching examined 88 matched pairs.Treatment success was obtained in 31(35%)patients in Group I and 33(38%)patients in Group N(p=0.9)within 30 days with one session.Conclusion Radiolucent stones can be safely and effectively treated by shockwave lithotripsy with intravenous urography.展开更多
Objectives: To assess the efficiency in terms of cost-effectiveness (CE) of oral Renalof® treatment versus extracorporeal shockwave lithotripsy (ESWL) in the treatment of kidney stones ≤ 1 cm in Nicaragua. Metho...Objectives: To assess the efficiency in terms of cost-effectiveness (CE) of oral Renalof® treatment versus extracorporeal shockwave lithotripsy (ESWL) in the treatment of kidney stones ≤ 1 cm in Nicaragua. Methods: A cost-effectiveness economic evaluation was carried out based on the results obtained in the randomised, prospective, observational, single-blind, prospective, phase 2 clinical trial. Cost-effectiveness and the incremental cost-effectiveness ratio (ICER) were calculated. Economic data were obtained from the Economics Department of Clínica Senior in Managua, Nicaragua. The monetary cost was expressed in US dollars (USD). Results: Treatment with Renalof® yielded a CE of $1,323.08/% remission, while ESWL was $9,498.54/% remission. The ICER shows that, in order to achieve a high percentage of kidney stone remission with ESWL, an extra $4,734.70 per patient must be invested. Conclusions: The use of Renalof® is shown to be a more cost-effective option than ESWL. It is recommended for the treatment of kidney stones ≤ 1 cm in size.展开更多
Background:Despite the continuous update of guidelines for the management of kidney stones,the ability to predict a successful response to extracorporeal shockwave lithotripsy(SWL)remains a topic of research.This is d...Background:Despite the continuous update of guidelines for the management of kidney stones,the ability to predict a successful response to extracorporeal shockwave lithotripsy(SWL)remains a topic of research.This is due to the need to refine the decision making in the context of technological advancements and current pandemics.This study aimed to determine the predictors of stone-free rate(SFR)after single-session SWL in adult patients with a single kidney stone 10 to 20 mm in diameter.Materials and methods:A retrospective review of the records of patients with a single kidney stone 10 to 20 mm in diameter was performed at a private SWL center from December 2019 to February 2021.Univariate and multivariate analyses were performed for stoneand patient-related factors,using the Student t and Mann-Whitney U tests for the quantitative variables and the Fisher exact and Pearson correlation tests for the qualitative variables.Results:A total of 138 patients were eligible for this study,including 92 men and 46 women.The mean age was 38.6±12.4years,and the mean body mass index(BMI)was 25.9±3.4kg/m^(2).Four weeks after SWL,120 patients(87%)were free of stones,and 18(13%)needed further treatment.Univariate analyses showed that SFR was negatively correlated with increased BMI(p=0.0001),maximum stone length(p=0.0001),transverse diameter of the stone(p=0.0001),number of shocks per session(p=0.052),and Hounsfield unit(HU)(p=0.0001).Multivariate analysis revealed that HU(p=0.009),maximum stone length(p=0.01),BMI(p=0.000),and presence of double-J stent(p=0.034)were independent risk factors for failure of single-session SWL in the treatment of kidney stones 10 to 20 mm in diameter.The estimated average cost per case was USD 450.5.Conclusions:Increased HU,maximum stone length,BMI,and presence of double-J stents were independent risk factors for low SFR after single-session SWL for a kidney stone 10 to 20 mm in diameter.The cost of SWL remains an advantage in the private sector.展开更多
BACKGROUND Pancreatic duct stones can lead to significant abdominal pain for patients.Per oral pancreatoscopy(POP)-guided intracorporal lithotripsy is being increasingly used for the management of main pancreatic duct...BACKGROUND Pancreatic duct stones can lead to significant abdominal pain for patients.Per oral pancreatoscopy(POP)-guided intracorporal lithotripsy is being increasingly used for the management of main pancreatic duct calculi(PDC)in chronic pancreatitis.POP uses two techniques:Electrohydraulic lithotripsy(EHL)and laser lithotripsy(LL).Data on the safety and efficacy are limited for this procedure.We performed a systematic review and meta-analysis with a primary aim to calculate the pooled technical and clinical success rates of POP.The secondary aim was to assess pooled rates of technical success,clinical success for the two individual techniques,and adverse event rates.AIM To perform a systematic review and meta-analysis of POP,EHL and LL for management of PDC in chronic pancreatitis.METHODS We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed,EMBASE,Cochrane,Google Scholar and Web of Science databases(from 1999 to October 2019)to identify studies with patient age greater than 17 and any gender that reported on outcomes of POP,EHL and LL.The primary outcome assessed involved the pooled technical success and clinical success rate of POP.The secondary outcome included the pooled technical success and clinical success rate for EHL and LL.We also assessed the pooled rate of adverse events for POP,EHL and LL including a subgroup analysis for the rate of adverse event subtypes for POP:Hemorrhage,post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP),perforation,abdominal pain,fever and infections.Technical success was defined as the rate of clearing pancreatic duct stones and clinical success as the improvement in pain.Randomeffects model was used for analysis.Heterogeneity between study-specific estimates was calculated using the Cochran Q statistical test and I2 statistics.Publication bias was ascertained,qualitatively by visual inspection of funnel plot and quantitatively by the Egger test.RESULTS A total of 16 studies including 383 patients met the inclusion criteria.The technical success rate of POP was 76.4%(95%CI:65.9-84.5;I2=64%)and clinical success rate was 76.8%(95%CI:65.2-85.4;I2=66%).The technical success rate of EHL was 70.3%(95%CI:57.8-80.3;I2=36%)and clinical success rate of EHL was 66.5%(95%CI:55.2-76.2;I2=19%).The technical success rate of LL was 89.3%(95%CI:70.5-96.7;I2=70%)and clinical success rate of LL was 88.2%(95%CI:66.4-96.6;I2=77%).The incidence of pooled adverse events for POP was 14.9%(95%CI:9.2-23.2;I2=49%),for EHL was 11.2%(95%CI:5.9-20.3;I2=15%)and for LL was 13.1%(95%CI:6.3-25.4;I2=31%).Subgroup analysis of adverse events showed rates of PEP at 7%(95%CI:3.5-13.6;I2=38%),fever at 3.7%(95%CI:2-6.9;I2=0),abdominal pain at 4.7%(95%CI:2.7-7.8;I2=0),perforation at 4.3%(95%CI:2.1-8.4;I2=0),hemorrhage at 3.4%(95%CI:1.7-6.6;I2=0)and no mortality.There was evidence of publication bias based on funnel plot analysis and Egger’s test.CONCLUSION Our study highlights the high technical and clinical success rates for POP,EHL and LL.POP-guided lithotripsy could be a viable option for management of chronic pancreatitis with PDC.展开更多
AIM: To evaluate the effect of cholecystokinin (CCK) during extracorporeal shockwave lithotripsy (ESWL) in the clearance of common bile duct (CBD) stones in endoscopic retrograde cholangiopancreatography (ERCP).
Urinary tract stone disease is seen at a level of 1%-2% in childhood(< 18 years).In recent years,however,there has been a marked increased in pediatric stone disease,particularly in adolescence.A carbohydrateand sa...Urinary tract stone disease is seen at a level of 1%-2% in childhood(< 18 years).In recent years,however,there has been a marked increased in pediatric stone disease,particularly in adolescence.A carbohydrateand salt-heavy diet and a more sedentary lifestyle are implicated in this increase.Although stone disease is rare in childhood,its presence is frequently associated with metabolic or anatomical disorders or infectious conditions,for which reason there is a high possibility of post-therapeutic recurrence.Factors such as a high possibility of recurrence and increasing incidence further enhance the importance of minimally invasive therapeutic options in children,with their expectations of a long life.In children in whom active stone removal is decided on,the way to achieve the highest level of success with the least morbidity is to select the most appropriate treatment modality.Thanks to today's advanced technology,renal stones that were once treated only by surgery can now be treated with minimally in-vasive techniques,from invasion of the urinary system in an antegrade(percutaneous nephrolithotomy) or retrograde(retrograde intrarenal surgery) manner or shock wave lithotripsy to laparoscopic stone surgery.This compilation study examined studies involving the RIRS procedure,the latest minimally invasive technique,in children and compared the results of those studies with those from other techniques.展开更多
Background Tamsulosin, an alpha-1 receptor antagonist, has been demonstrated effective in promoting distal ureteral stone passage and in reducing pain associated with stone expulsion. This study aimed to evaluate the ...Background Tamsulosin, an alpha-1 receptor antagonist, has been demonstrated effective in promoting distal ureteral stone passage and in reducing pain associated with stone expulsion. This study aimed to evaluate the effect of tamsulosin in comparison with nifedipine and extracorporeal shock wave lithotripsy （ESWL） on the expulsion rate of distal ureteral stones at different sizes. Methods We assigned 314 patients to three categories： Ⅰ, the stone with maximal diameter of 4.0-5.9 mm; Ⅱ, 6.0-7.9 mm, and Ⅲ, 8.0-9.9 mm. Patients in each category were randomly subdivided into three treatment subgroups： group A （nifedipine group）, group B （tamsulosin group）, and group C （ESWL group）. Stone-free rate and the dose of analgesics were recorded weekly during the 4-week follow-up period. Results Three hundred and three patients completed the study. The results showed that nifedipine and tamsulosin treatments promoted a small （4-8 mm, categories Ⅰ and Ⅱ） stone expulsive rate that was comparable with ESWL treatment. Nonetheless, when the stone diameter was 8.0-9.9 mm, ESWL showed a greater stone free rate than nifedipine and tamsulosin treatments; no significant difference existed between the latter two therapies. Although the ESWL treatment group required the least analgesics, tamsulosin treatments required less pain medication than nifedipine （P 〈0.05）. Conclusions Tamsulosin treatment is recommended for patients with the stone diameter smaller than 8 mm because of its feasibility, effectiveness and safety. ESWL is more appropriate than tamsulosin therapy for the patients whose stones are larger than 8 mm.展开更多
Background:Horseshoe kidney is a rare congenital anomaly commonly complicated by urolithiasis.Extracorporeal shockwave lithotripsy(ESWL),ureteroscopy(URS),and percutaneous nephrolithotomy(PCNL)are treatment options fo...Background:Horseshoe kidney is a rare congenital anomaly commonly complicated by urolithiasis.Extracorporeal shockwave lithotripsy(ESWL),ureteroscopy(URS),and percutaneous nephrolithotomy(PCNL)are treatment options for horseshoe kidney stones.The aim of this systematic review is to compare the benefits and risks of these management options.Methods:MEDLINE,EMBASE,and Cochrane Library databases were searched from inception to February 2022.A total of 516 nonduplicate studies were screened against the inclusion and exclusion criteria.Studies comparing at least 2 interventions with>10 patients per intervention were included.Results:Nine retrospective observational studies published from 2007 to 2021 with a total of 565 patients were included.Reported mean±SD or mean(range)stone sizes ranged between 17.90±2.43 mm and 27.9±8.6 mm for PCNL,8.4(2-25)mm and 22.3±9.1 mm for URS,and 11.9±2.0 mm and 16.8±4.4 mm for ESWL.There was no difference in single-session and overall stone-free rate(SFR)between PCNL and URS,with a risk ratio of 1.04(95%confidence interval,0.95-1.13;I2=20.63%).Ureteroscopy had better stone clearance than ESWL,with an overall SFR risk ratio of1.38(95%confidence interval,1.04-1.82;I2=0%).There was no statistically significant difference in overall SFR between PCNL and ESWL.Most patients who underwent URS and ESWL experienced Clavien-Dindo(CD)gradeⅠ-Ⅱcomplications.Percutaneous nephrolithotomy was associated with the highest complication rates,including 5 CD gradeⅢand 3 CD gradeⅣcomplications and a mean postoperative hemoglobin drop of 0.47 to 1.83 g/dL.There were no CD grade V complications across all studies.Conclusions:There was no difference in SFR between PCNL and URS.Ureteroscopy was associated with a smaller stone burden and fewer and less severe complications.Ureteroscopy was found to be more effective than ESWL with a higher SFR and comparable safety profile.Further large-scale randomized controlled trials are needed to confirm these findings.展开更多
文摘Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral stones.Methods We retrospectively reviewed 734 patients with ureteral stones treated by fluoroscopy-guided shockwave lithotripsy between March 2014 and March 2021.The primary outcome was a stone-free rate with one session within 30 days,defined as no residual stones without auxiliary treatment.The multivariate analysis was used to examine whether the intravenous urography use predicted treatment success.Furthermore,we compared the outcomes using propensity score matching.Results Ninety-eight patients underwent the intravenous urography use protocol(Group I),and the remaining 636 patients underwent the non-intravenous urography protocol(Group N).Stone-free rates with one session within 30 days were 38%and 32%in groups I and N,respectively(p=0.3).No statistical differences were observed in the conversion rate to ureteroscopy(p=0.3)or complication rate(p=0.7)between Group I and Group N.One patient who developed skin redness was considered a complication of the contrast medium.Propensity score matching examined 88 matched pairs.Treatment success was obtained in 31(35%)patients in Group I and 33(38%)patients in Group N(p=0.9)within 30 days with one session.Conclusion Radiolucent stones can be safely and effectively treated by shockwave lithotripsy with intravenous urography.
文摘Objectives: To assess the efficiency in terms of cost-effectiveness (CE) of oral Renalof® treatment versus extracorporeal shockwave lithotripsy (ESWL) in the treatment of kidney stones ≤ 1 cm in Nicaragua. Methods: A cost-effectiveness economic evaluation was carried out based on the results obtained in the randomised, prospective, observational, single-blind, prospective, phase 2 clinical trial. Cost-effectiveness and the incremental cost-effectiveness ratio (ICER) were calculated. Economic data were obtained from the Economics Department of Clínica Senior in Managua, Nicaragua. The monetary cost was expressed in US dollars (USD). Results: Treatment with Renalof® yielded a CE of $1,323.08/% remission, while ESWL was $9,498.54/% remission. The ICER shows that, in order to achieve a high percentage of kidney stone remission with ESWL, an extra $4,734.70 per patient must be invested. Conclusions: The use of Renalof® is shown to be a more cost-effective option than ESWL. It is recommended for the treatment of kidney stones ≤ 1 cm in size.
文摘Background:Despite the continuous update of guidelines for the management of kidney stones,the ability to predict a successful response to extracorporeal shockwave lithotripsy(SWL)remains a topic of research.This is due to the need to refine the decision making in the context of technological advancements and current pandemics.This study aimed to determine the predictors of stone-free rate(SFR)after single-session SWL in adult patients with a single kidney stone 10 to 20 mm in diameter.Materials and methods:A retrospective review of the records of patients with a single kidney stone 10 to 20 mm in diameter was performed at a private SWL center from December 2019 to February 2021.Univariate and multivariate analyses were performed for stoneand patient-related factors,using the Student t and Mann-Whitney U tests for the quantitative variables and the Fisher exact and Pearson correlation tests for the qualitative variables.Results:A total of 138 patients were eligible for this study,including 92 men and 46 women.The mean age was 38.6±12.4years,and the mean body mass index(BMI)was 25.9±3.4kg/m^(2).Four weeks after SWL,120 patients(87%)were free of stones,and 18(13%)needed further treatment.Univariate analyses showed that SFR was negatively correlated with increased BMI(p=0.0001),maximum stone length(p=0.0001),transverse diameter of the stone(p=0.0001),number of shocks per session(p=0.052),and Hounsfield unit(HU)(p=0.0001).Multivariate analysis revealed that HU(p=0.009),maximum stone length(p=0.01),BMI(p=0.000),and presence of double-J stent(p=0.034)were independent risk factors for failure of single-session SWL in the treatment of kidney stones 10 to 20 mm in diameter.The estimated average cost per case was USD 450.5.Conclusions:Increased HU,maximum stone length,BMI,and presence of double-J stents were independent risk factors for low SFR after single-session SWL for a kidney stone 10 to 20 mm in diameter.The cost of SWL remains an advantage in the private sector.
文摘BACKGROUND Pancreatic duct stones can lead to significant abdominal pain for patients.Per oral pancreatoscopy(POP)-guided intracorporal lithotripsy is being increasingly used for the management of main pancreatic duct calculi(PDC)in chronic pancreatitis.POP uses two techniques:Electrohydraulic lithotripsy(EHL)and laser lithotripsy(LL).Data on the safety and efficacy are limited for this procedure.We performed a systematic review and meta-analysis with a primary aim to calculate the pooled technical and clinical success rates of POP.The secondary aim was to assess pooled rates of technical success,clinical success for the two individual techniques,and adverse event rates.AIM To perform a systematic review and meta-analysis of POP,EHL and LL for management of PDC in chronic pancreatitis.METHODS We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed,EMBASE,Cochrane,Google Scholar and Web of Science databases(from 1999 to October 2019)to identify studies with patient age greater than 17 and any gender that reported on outcomes of POP,EHL and LL.The primary outcome assessed involved the pooled technical success and clinical success rate of POP.The secondary outcome included the pooled technical success and clinical success rate for EHL and LL.We also assessed the pooled rate of adverse events for POP,EHL and LL including a subgroup analysis for the rate of adverse event subtypes for POP:Hemorrhage,post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP),perforation,abdominal pain,fever and infections.Technical success was defined as the rate of clearing pancreatic duct stones and clinical success as the improvement in pain.Randomeffects model was used for analysis.Heterogeneity between study-specific estimates was calculated using the Cochran Q statistical test and I2 statistics.Publication bias was ascertained,qualitatively by visual inspection of funnel plot and quantitatively by the Egger test.RESULTS A total of 16 studies including 383 patients met the inclusion criteria.The technical success rate of POP was 76.4%(95%CI:65.9-84.5;I2=64%)and clinical success rate was 76.8%(95%CI:65.2-85.4;I2=66%).The technical success rate of EHL was 70.3%(95%CI:57.8-80.3;I2=36%)and clinical success rate of EHL was 66.5%(95%CI:55.2-76.2;I2=19%).The technical success rate of LL was 89.3%(95%CI:70.5-96.7;I2=70%)and clinical success rate of LL was 88.2%(95%CI:66.4-96.6;I2=77%).The incidence of pooled adverse events for POP was 14.9%(95%CI:9.2-23.2;I2=49%),for EHL was 11.2%(95%CI:5.9-20.3;I2=15%)and for LL was 13.1%(95%CI:6.3-25.4;I2=31%).Subgroup analysis of adverse events showed rates of PEP at 7%(95%CI:3.5-13.6;I2=38%),fever at 3.7%(95%CI:2-6.9;I2=0),abdominal pain at 4.7%(95%CI:2.7-7.8;I2=0),perforation at 4.3%(95%CI:2.1-8.4;I2=0),hemorrhage at 3.4%(95%CI:1.7-6.6;I2=0)and no mortality.There was evidence of publication bias based on funnel plot analysis and Egger’s test.CONCLUSION Our study highlights the high technical and clinical success rates for POP,EHL and LL.POP-guided lithotripsy could be a viable option for management of chronic pancreatitis with PDC.
文摘AIM: To evaluate the effect of cholecystokinin (CCK) during extracorporeal shockwave lithotripsy (ESWL) in the clearance of common bile duct (CBD) stones in endoscopic retrograde cholangiopancreatography (ERCP).
文摘Urinary tract stone disease is seen at a level of 1%-2% in childhood(< 18 years).In recent years,however,there has been a marked increased in pediatric stone disease,particularly in adolescence.A carbohydrateand salt-heavy diet and a more sedentary lifestyle are implicated in this increase.Although stone disease is rare in childhood,its presence is frequently associated with metabolic or anatomical disorders or infectious conditions,for which reason there is a high possibility of post-therapeutic recurrence.Factors such as a high possibility of recurrence and increasing incidence further enhance the importance of minimally invasive therapeutic options in children,with their expectations of a long life.In children in whom active stone removal is decided on,the way to achieve the highest level of success with the least morbidity is to select the most appropriate treatment modality.Thanks to today's advanced technology,renal stones that were once treated only by surgery can now be treated with minimally in-vasive techniques,from invasion of the urinary system in an antegrade(percutaneous nephrolithotomy) or retrograde(retrograde intrarenal surgery) manner or shock wave lithotripsy to laparoscopic stone surgery.This compilation study examined studies involving the RIRS procedure,the latest minimally invasive technique,in children and compared the results of those studies with those from other techniques.
文摘Background Tamsulosin, an alpha-1 receptor antagonist, has been demonstrated effective in promoting distal ureteral stone passage and in reducing pain associated with stone expulsion. This study aimed to evaluate the effect of tamsulosin in comparison with nifedipine and extracorporeal shock wave lithotripsy （ESWL） on the expulsion rate of distal ureteral stones at different sizes. Methods We assigned 314 patients to three categories： Ⅰ, the stone with maximal diameter of 4.0-5.9 mm; Ⅱ, 6.0-7.9 mm, and Ⅲ, 8.0-9.9 mm. Patients in each category were randomly subdivided into three treatment subgroups： group A （nifedipine group）, group B （tamsulosin group）, and group C （ESWL group）. Stone-free rate and the dose of analgesics were recorded weekly during the 4-week follow-up period. Results Three hundred and three patients completed the study. The results showed that nifedipine and tamsulosin treatments promoted a small （4-8 mm, categories Ⅰ and Ⅱ） stone expulsive rate that was comparable with ESWL treatment. Nonetheless, when the stone diameter was 8.0-9.9 mm, ESWL showed a greater stone free rate than nifedipine and tamsulosin treatments; no significant difference existed between the latter two therapies. Although the ESWL treatment group required the least analgesics, tamsulosin treatments required less pain medication than nifedipine （P 〈0.05）. Conclusions Tamsulosin treatment is recommended for patients with the stone diameter smaller than 8 mm because of its feasibility, effectiveness and safety. ESWL is more appropriate than tamsulosin therapy for the patients whose stones are larger than 8 mm.
文摘Background:Horseshoe kidney is a rare congenital anomaly commonly complicated by urolithiasis.Extracorporeal shockwave lithotripsy(ESWL),ureteroscopy(URS),and percutaneous nephrolithotomy(PCNL)are treatment options for horseshoe kidney stones.The aim of this systematic review is to compare the benefits and risks of these management options.Methods:MEDLINE,EMBASE,and Cochrane Library databases were searched from inception to February 2022.A total of 516 nonduplicate studies were screened against the inclusion and exclusion criteria.Studies comparing at least 2 interventions with>10 patients per intervention were included.Results:Nine retrospective observational studies published from 2007 to 2021 with a total of 565 patients were included.Reported mean±SD or mean(range)stone sizes ranged between 17.90±2.43 mm and 27.9±8.6 mm for PCNL,8.4(2-25)mm and 22.3±9.1 mm for URS,and 11.9±2.0 mm and 16.8±4.4 mm for ESWL.There was no difference in single-session and overall stone-free rate(SFR)between PCNL and URS,with a risk ratio of 1.04(95%confidence interval,0.95-1.13;I2=20.63%).Ureteroscopy had better stone clearance than ESWL,with an overall SFR risk ratio of1.38(95%confidence interval,1.04-1.82;I2=0%).There was no statistically significant difference in overall SFR between PCNL and ESWL.Most patients who underwent URS and ESWL experienced Clavien-Dindo(CD)gradeⅠ-Ⅱcomplications.Percutaneous nephrolithotomy was associated with the highest complication rates,including 5 CD gradeⅢand 3 CD gradeⅣcomplications and a mean postoperative hemoglobin drop of 0.47 to 1.83 g/dL.There were no CD grade V complications across all studies.Conclusions:There was no difference in SFR between PCNL and URS.Ureteroscopy was associated with a smaller stone burden and fewer and less severe complications.Ureteroscopy was found to be more effective than ESWL with a higher SFR and comparable safety profile.Further large-scale randomized controlled trials are needed to confirm these findings.
