Comparison and outcomes of dusting versus stone fragmentation and extraction in retrograde intrarenal surgery: results of a systematic review and meta-analysis.

Autor:	Gauhar V; Ng Teng Fong General Hospital, Department of Urology, Singapore, Singapore., Teoh JY; S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China., Mulawkar PM; Tirthankar Super Specialty Hospital, Department of Urology, Akola, India.; University of Edinburgh, Edinburgh, United Kingdom., Tak GR; Asian Institute of Nephrology and Urology, Hyderabad, India., Wroclawski ML; Hospital Israelita Albert Einstein, BP - the Portuguese Beneficence of São Paulo, Sao Paulo-SP, Brazil.; ABC School of Medicine, Santo André-SP, Santo André-SP, Brazil., Robles-Torres JI; Hospital Universitario 'Dr. José Eleuterio Gonzalez', Department of Urology, Monterrey, México., Chan VW; School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom., García Rojo E; Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain., da Silva RD; University of Colorado, School of Medicine, Department of Urology, Denver, Colorado, USA., Tanidir Y; Marmara University School of Medicine, Department of Urology, Istanbul, Turkey., Tiong HY; National University Hospital, Department of Urology, Singapore, Singapore., Sener TE; Marmara University School of Medicine, Department of Urology, Istanbul, Turkey., Heldwein FL; Federal University of Santa Catarina, Department of Urology , Florianopolis, Brazil., Somani BK; University Hospitals Southampton NHS Trust, Department of Urology, Southampton, United Kingdom., Castellani D; Università Politecnica delle Marche , Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Urology Unit, Ancona, Italy.
Jazyk:	angličtina
Zdroj:	Central European journal of urology [Cent European J Urol] 2022; Vol. 75 (3), pp. 317-327. Date of Electronic Publication: 2022 Sep 06.
DOI:	10.5173/ceju.2022.0148
Abstrakt:	Introduction: Lithotripsy during retrograde intrarenal surgery (RIRS) can be achieved either by fragmentation and extraction or dusting with spontaneous passage. We aimed to perform a systematic review on the safety and stone-free rate after RIRS by comparing the techniques of dusting vs fragmentation/extraction. Material and Methods: This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The inverse variance of the mean difference and 95% Confidence Interval (CI), Categorical variables were assessed using Cochran-Mantel-Haenszel Method with the random effect model and reported as Odds Ratio (OR) and 95% CI. Statistical significance was set at p <0.05. Results: There were 1141 patients included in 10 studies. Stone size was up to 2.5 cm All studies used holmium laser for lithotripsy. Meta-analysis showed no significant difference in surgical time (MD -5.39 minutes 95% CI -13.92-2.31, p = 0.16), postoperative length of stay (MD -0.19 days 95% CI -0.60 - -0.22, p=0.36), overall complications (OR 0.98 95% CI 0.58-1.66, p = 0.95), hematuria (OR 1.01 95% CI 0.30-3.42, p = 0.99), postoperative fever (OR 0.70 95% CI 0.41-1.19, p = 0.19) and sepsis (OR 1.03 95% CI 0.10-10.35, p = 0.98), immediate (OR 0.40 95% CI 0.13-1.24, p = 0.11) and overall stone-free rate (OR 0.76 95% CI 0.43-1.32, p = 0.33), and retreatment rate (OR 1.35 95% CI 0.57-3.20, p = 0.49) between the groups. Conclusions: This systematic review infers that urologists can safely use either option of fragmentation and basket extraction or dusting without extraction to achieve similar outcomes as both techniques are similar for efficacy and safety. Competing Interests: Rodrigo Donalisio da Silva is a consultant for Lumenis. Jeremy Yuen-Chun Teoh had honorarium/lecture for: Astellas, Boston Scientific, Combat Medical, Ferring, Ipsen, Janssen, Olympus, Sanofy. Jeremy Yuen-Chun Teoh is a consultant for: Astellas, Combat Medical, Ferring, Janssen, MRI PRO. Jeremy Yuen-Chun Teoh had research grant from: Baxter, Janssen, Storz, Olympus, Bristol-Meyers Squibb, Merck Sharp & Dohme. The remaining authors declare that they have no conflict of interest. (Copyright by Polish Urological Association.)
Databáze:	MEDLINE
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