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Meta-analysis of Optimal Management of Lower Pole Stone of 10 - 20 mm: Flexible Ureteroscopy (FURS) versus Extracorporeal Shock Wave Lithotripsy (ESWL) versus Percutaneus Nephrolithotomy (PCNL)

ACTA MEDICA INDONESIANA · Vol. 50 No. 1 (2018)

ISSN
2338-2732, 0125-9326
Terbit
2018-04-20
Penerbit
The Indonesian Society of Internal Medicine
Bahasa
eng

Abstrak

Background: the optimal management of lower calyceal stones is still controversial, because no single method is suitable for the removal of all lower calyceal stones. Minimally invasive procedures such as extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and flexible ureteroscopy (fURS) are the therapeutic methods for lower calyceal stones. The aim of this study was to identify the optimal management of 10-20 mm lower pole stones. Methods: a meta-analysis of cohort studies published before July 2016 was performed from Medline and Cochrane databases. Management of 10-20 mm lower pole stone treated by fURS, ESWL and PCNL with follow-up of residual stones in 1-3 months after procedure were include and urinary stone in other location and size were excluded. A fixed-effects model with Mantzel-Haenzel method was used to calculate the pooled Risk Ratio (RRs) and 95% Confidence Interval (CIs). We assessed the heterogeneity by calculating the I2 statistic. All analyses were performed with Review manager 5.3. Results: we analized 8 cohort studies. The stone free rate from 958 patients (271 PCNL, 174 fURS and 513 ESWL), 3 months after operation, was 90.8% (246/271) after PCNL; 75.3% (131/174) after fURS; and 64.7% (332/513) after ESWL. Base on stone free rate in 10-20 mm lower pole stone following management, PCNL is better than fURS (overall RR was 1.32 (95% CI 1.13 – 1.55); p<0.001 and I2=57%) and ESWL (overall risk ratio 1.42 (95% CI 1.30 – 1.55); p=<0.001 and I2 = 85%). But, if we compare between fURS and ESWL, fURS is better than ESWL base on stone free rate in 10-20 mm lower pole stone management with overall RR 1.16 (95% CI 1.04 – 1.30; p=0.01 and I2=40%). Conclusion: percutaneus nephrolithotomy provided a higher stone free rate than fURS and ESWL. This meta-analysis may help urologist in making decision of intervention in 10-20 mm lower pole stone management.

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  • Universitas Gadjah Mada
  • Cenderawasih University
  • Rumah Sakit Umum Pusat Dr. Sardjito
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Zulfikar AliAfiliasi tidak diketahui3
Arry RodjaniAfiliasi tidak diketahui2
Donny Eka PutraAfiliasi tidak diketahui2
Mewahyu DewiAfiliasi tidak diketahui2
Akmal TaherAfiliasi tidak diketahui2
Grace WanggeAfiliasi tidak diketahui1
Fatan AbshariAfiliasi tidak diketahui1
Adistra I.T.W.H SatjakoesoemahAfiliasi tidak diketahui1
Perdana R PerdanaAfiliasi tidak diketahui1
Candra D.K WijayaAfiliasi tidak diketahui1
Chaidir A MochtarAfiliasi tidak diketahui1
Ari AstramAfiliasi tidak diketahui1
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R. DanartoAfiliasi tidak diketahui1
Rainy UmbasAfiliasi tidak diketahui1
Agus Rizal A.H. HamidAfiliasi tidak diketahui1
IRFAN WAHYUDICenderawasih University1
Pande Made Wisnu TirtayasaAfiliasi tidak diketahui1
Gede Wirya Kusuma DuarsaAfiliasi tidak diketahui1
Gerhard Reinaldi SitumorangAfiliasi tidak diketahui1
I Wayan YudianaAfiliasi tidak diketahui1
Kadek Budi SantosaAfiliasi tidak diketahui1
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Dina ElitaAfiliasi tidak diketahui1
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Jesslyn MelleniaAfiliasi tidak diketahui1
R. Mohamad JavierAfiliasi tidak diketahui1
Eldo Taufila Putra UtamaRumah Sakit Umum Pusat Dr. Sardjito1

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Sumber metadata: OAI-PMH (metadata jurnal) http://www.actamedindones.org/index.php/ijim/oai, pertama di-harvest 8 Nov 2026, terakhir terlihat 8 Nov 2026.
Metadata asli (oai_dc) 
<oai_dc:dc xmlns="http://www.openarchives.org/OAI/2.0/" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/  http://www.openarchives.org/OAI/2.0/oai_dc.xsd">
	<dc:title xml:lang="en-US">Meta-analysis of Optimal Management of Lower Pole Stone of 10 - 20 mm: Flexible Ureteroscopy (FURS) versus Extracorporeal Shock Wave Lithotripsy (ESWL) versus Percutaneus Nephrolithotomy (PCNL)</dc:title>
	<dc:creator>Yuri, Prahara</dc:creator>
	<dc:creator>Hariwibowo, Rinto</dc:creator>
	<dc:creator>Soeroharjo, Indrawarman</dc:creator>
	<dc:creator>Danarto, Raden</dc:creator>
	<dc:creator>Hendri, Ahmad Z</dc:creator>
	<dc:creator>Brodjonegoro, Sakti R</dc:creator>
	<dc:creator>Rasyid, Nur</dc:creator>
	<dc:creator>Birowo, Ponco</dc:creator>
	<dc:creator>Widyahening, Indah S</dc:creator>
	<dc:subject xml:lang="en-US">lower pole stone</dc:subject>
	<dc:subject xml:lang="en-US">flexible ureteroscopy</dc:subject>
	<dc:subject xml:lang="en-US">extracorporeal shock wave lithotripsy</dc:subject>
	<dc:subject xml:lang="en-US">percutaneus nephrolithotomy</dc:subject>
	<dc:description xml:lang="en-US">Background: the optimal management of lower calyceal stones is still controversial, because no single method is suitable for the removal of all lower calyceal stones. Minimally invasive procedures such as extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and flexible ureteroscopy (fURS) are the therapeutic methods for lower calyceal stones. The aim of this study was to identify the optimal management of 10-20 mm lower pole stones. Methods: a meta-analysis of cohort studies published before July 2016 was performed from Medline and Cochrane databases. Management of 10-20 mm lower pole stone treated by fURS, ESWL and PCNL with follow-up of residual stones in 1-3 months after procedure were include and urinary stone in other location and size were excluded. A fixed-effects model with Mantzel-Haenzel method was used to calculate the pooled Risk Ratio (RRs) and 95% Confidence Interval (CIs). We assessed the heterogeneity by calculating the I2 statistic. All analyses were performed with Review manager 5.3. Results: we analized 8 cohort studies. The stone free rate from 958 patients (271 PCNL, 174 fURS and 513 ESWL), 3 months after operation, was 90.8% (246/271) after PCNL; 75.3% (131/174) after fURS; and 64.7% (332/513) after ESWL. Base on stone free rate in 10-20 mm lower pole stone following management, PCNL is better than fURS (overall RR was 1.32 (95% CI 1.13 – 1.55); p&amp;lt;0.001 and I2=57%) and ESWL (overall risk ratio 1.42 (95% CI 1.30 – 1.55); p=&amp;lt;0.001 and I2 = 85%). But, if we compare between fURS and ESWL, fURS is better than ESWL base on stone free rate in 10-20 mm lower pole stone management with overall RR 1.16 (95% CI 1.04 – 1.30; p=0.01 and I2=40%). Conclusion: percutaneus nephrolithotomy provided a higher stone free rate than fURS and ESWL. This meta-analysis may help urologist in making decision of intervention in 10-20 mm lower pole stone management.</dc:description>
	<dc:publisher xml:lang="en-US">The Indonesian Society of Internal Medicine</dc:publisher>
	<dc:date>2018-04-20</dc:date>
	<dc:type>info:eu-repo/semantics/article</dc:type>
	<dc:type>info:eu-repo/semantics/publishedVersion</dc:type>
	<dc:format>application/pdf</dc:format>
	<dc:identifier>http://www.actamedindones.org/index.php/ijim/article/view/460</dc:identifier>
	<dc:source xml:lang="en-US">Acta Medica Indonesiana; Vol. 50 No. 1 (2018): Acta Medica Indonesiana; 18</dc:source>
	<dc:source>2338-2732</dc:source>
	<dc:source>0125-9326</dc:source>
	<dc:language>eng</dc:language>
	<dc:relation>http://www.actamedindones.org/index.php/ijim/article/view/460/pdf</dc:relation>
	<dc:rights xml:lang="en-US">Copyright (c) 2018 Acta Medica Indonesiana</dc:rights>
</oai_dc:dc>