Does prior failed shock-wave lithotripsy impact outcomes of ureterorenoscopy? A systematic review and meta-analysis.

ABSTRACT

OBJECTIVE: The study aimed to compare the outcomes of patients undergoing ureterorenoscopy (URS) after failed shock-wave lithotripsy (SWL) (Salvage URS) with those undergoing URS without any history of SWL (Primary URS). MATERIALS AND METHODS: PubMed, Embase, and CENTRAL databases were searched up to 10th January 2021 for studies comparing outcomes of salvage URS vs. primary URS. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for procedure success and complications. Operating time was summarized using mean difference (MD). RESULTS: Seven retrospective studies were included. Meta-analysis indicated no statistically significant difference in the success rates of URS between the salvage URS and primary URS groups (OR 0.83 95% CI 0.65, 1.06 I2=0% p=0.13). On subgroup analysis, the success rate was significantly reduced in the salvage URS group for renal stones (OR 0.55 95% CI 0.34, 0.91 I2=0% p=0.02) but with no difference for ureter stones OR 0.90 95% CI 0.67, 1.21 I2=0% p=0.49). Pooled analysis demonstrated a tendency of longer operating time in the salvage URS group as compared to the primary URS group, albeit with a statistically non-significant difference (MD 8.91 95% CI -0.56, 18.38 I2=98% p=0.07). Meta-analysis indicated significantly increased complications in the salvage URS group as compared to the primary URS group (OR 1.83 95% CI 1.34, 2.49 I2=0% p=0.0001). CONCLUSIONS: Evidence from retrospective studies suggests that patients undergoing salvage URS for renal stones have significantly lower success rates which is not the case for ureteral stones. There is a non-significant tendency of increased operating times for salvage URS. Complication rates are significantly higher for salvage URS as compared to primary URS. Future studies with propensity-score matching are required to strengthen current conclusions.