Urolithiasis management: An umbrella review on the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) versus the ureteroscopic approach

Abstract

This Umbrella Review aims to gather high-quality evidence on urolithiasis outcomes and complications, comparing extracorporeal shockwave lithotripsy (ESWL), ureteroscopic lithotripsy (URSL), and retrograde intrarenal surgery (RIRS). We incorporated systematic reviews, some containing meta-analyses, into two separate reports, focusing on quantitative and qualitative results. Additionally, when data permitted, a secondary meta-analysis was conducted using final effect estimates from multiple meta-analyses. Stone-free rate (SFR) served as the primary outcome, with complications, retreatment, and hospital stay as secondary outcomes. Adhering to Joanna Briggs Institute (JBI) guidelines, we initially screened 282 titles, narrowed down to 166 titles and abstracts, ultimately selecting 55 full-text articles for review. Of these, 22 met our inclusion criteria for the umbrella review. We evaluated study quality using JBI criteria, excluding five low-quality studies. Analysis showed ESWL had lower SFR compared to RIRS (RR: 0.577, 95% CI: 0.482–0.692) and URSL (RR: 0.570, 95% CI: 0.450–0.722); lower overall risk compared to ureteroscopy (RR: 0.58, 95% CI: 0.51–0.66). ESWL had fewer complications than RIRS (p < 0.001), but lower SFR than ureteroscopy. However, the need for retreatment and auxiliary procedures in RIRS and URSL were lower than that in ESWL. In contrast, individuals undergoing ureteroscopy experienced a greater frequency of complications and longer duration of operation compared to those undergoing ESWL.