The Efficiency And Safety Of Transurethral Ureteroscopic Holmium Laser Lithotripsy And Retroperitoneal Laparoscopic Ureterolithotomyfor The Treatment Of Upper Ureteral Calculi-a Meta Analysis

Objective: To compare the effectiveness and safety of transurethral ureteroscopic holmium laser lithotripsy and retroperitoneal laparoscopic ureterolithotomy for the treatment of upper ureteral calculi.Methods: A research for articles from Jan.2010 to Dec 2018 related to the comparative effectiveness and safety of transurethral ureteroscopic holmium laser lithotripsy and retroperitoneal laparoscopic ureterolithotomy for the treatment of upper ureteral calculi was ran on Pubmed,Dspace,Science Research Network,CNKI,Cochrane Library,EAU.After the literature was processed by two people according to the standard,Meta analysis was performed using Revman5.provided by Cochrane.Results: A total of 8 studies were included,including 960 patients,539 patients in the transurethral ureteroscopic holmium laser lithotripsy(TUL)group,and 421 patients in the retroperitoneal laparoscopic ureterolithotomy(RLU)group.Meta-analysis was performed on all 8 studies,Results are as follows:1.The stone free rate of the TUL group was lower than that of the RLU group [OR=0.08,95% CI(0.04,0.16),P<0.00001].2.The operation time of the TUL group was smaller than that of the RLU group [MD=-23.74,95% CI(-33.99,-13.49),P<0.00001].3.The number of hospital stays in the TUL group was smaller than that in the RLU group [MD=-1.28,95% CI(-2.02,-0.54),P=0.0007].4.There was no significant difference in the total incidence of postoperative complications between the TUL group and the RLU group [OR=1.2,95% CI(0.81,1.78),P=0.36].Subgroup analysis was performed according to the main postoperative complications: fever,urinary tract infection,urinary leakage,and ureteral stricture.The results showed that there was no significant difference in postoperative fever between TUL group and RLU group [OR=1.07,95% CI(0.47,2.42),P=0.88];there was no significant difference in urinary tract infection between the two groups.[OR=0.83,95% CI(0.29,2.33),P=0.72].However,the incidence of urinary leakage in the TUL group was lower than that in the RLU group [OR=0.16,95% CI(0.04,0.61),P=0.008];the incidence of ureteral stricture in the TUL group was higher than that in the RLU group [OR=3.85,95% CI(1.01),14.73),P=0.05].Conclusions: TUL has the advantages of short operation time,less postoperative hospital stay,and low postoperative urinary leakage in the treatment of upper ureteral calculi.RLU has the advantages of high stone free rate and low incidence of postoperative ureteral stricture in the treatment of upper ureteral calculi.There was no significant difference in the overall incidence of postoperative complications between TUL and RLU.