Extracorporeal Shock Wave Lithotripsy And Ureteroscopy For Stones<2cm In Horseshoe Kidney:A Meta-analysis

INTRODUCTION : No wound to the patients is the pursuit of surgeons.Extracorporeal shock wave lithotripsy(SWL)and ureteroscopy(FURS)are minimally invasive modalities for treating horseshoe kidney(HSK)stone <2 cm.We aimed to review the effectiveness and complications of SWL and FURS in HSK stone.METHODS:The literature was reviewed in the Embase,PubMed,and Cochrane Library up to March 1,2018.Only 4 articles were available for analysis.Inclusion criteria were all English language articles reporting on the comparison between SWL and FURS.Outcome measures set as:(1)initial stone free rate(after one session)(2)retreatment ratio(3)success rate(4)renal colic episodes(5)minor complications(6)severe complications.Severe complication was defined as more than Clavien-Dindo classification IIIb,such as bleeding with transfusion or Urosepsis.Minor complications were less than IIIa.And minor complications included the occurrence of renal colic.Success rate was defined as stone free after the final session.RESULTS:FURS tends to be performed in groups with a relativelyheavier stone burden.The higher initial stone-free rate and success rate were demonstrated for FURS than for SWL(RD =–0.41[–0.58-–0.23],p<0.00001;RD =–0.21[–0.39-–0.04],p = 0.02).The less retreatment rate was found in FURS than SWL(RD =0.15[0.01-0.30],p=0.04).No difference was found in minor complications(RD=–0.04[–0.19–0.10],p = 0.57).Renal colic episodes were more likely to be observed in the SWL group(RD =0.17[0.03-0.32],p=0.02).No major complications were reported.CONCLISONS:For a stone <2 cm in HSK,both SWL and FURS are safe treatment modalities.FURS alone is a more feasible and sufficient option for stone in HSK <2 cm than SWL.