Systematic review and meta-analysis of transgluteal versus prone approach to extracorporeal shockwave lithotripsy for patients with distal ureteral stones.

Abstract

To explore the effectiveness of transgluteal approach during extracorporeal shockwave lithotripsy (ESWL) for patients with distal ureteral stones compared to the prone approach. A systematic literature search was carried out by two reviewers independently on the basis of three electronic databases up to Aug. 2020. Three randomized controlled trials (RCT) and one cohort studies (CS), with a total of 516 patients, comparing transgluteal approach with prone approach during ESWL for distal ureteral stones were included. The methodological quality of RCT was evaluated by Cochrane collaboration s tools, and the quality of CS and CCS was evaluated by modified Newcatle-Ottawa scale. The weighted mean difference (WMD) and odds ratio (OR) was respectively used to describe results of continuous and dichotomous variables. Pooled data showed that transgluteal approach could significantly improve the rate of stone free after the first treatment [OR\xa0=\xa03.18, 95% confidence interval (CI) 2.19-4.63, p\xa0<\xa00.00001] and the rate of overall stone free (OR\xa0=\xa04.03, 95% CI 2.43-6.69, p\xa0<\xa00.00001). In addition, compared with the prone approach, the transgluteal one could also significantly reduce the rate of ureteroscopy (OR\xa0=\xa00.21, 95% CI 0.12-0.36, p\xa0<\xa00.00001). What s more, complications were rarely reported, which demonstrated a similar safety for two approaches. Our study suggested that, during ESWL for patients with distal ureteral stones, transgluteal approach was a safe and more effective choice than the prone position.