Efficacy of Extracorporeal Shock Wave Lithotripsy (ESWL) versus Pneumatic Ureteroscopic Lithotripsy (URSL) for Lower Ureteral Stones Therapy in Asia: A Meta-Analysis


Objective: To assess the efficacy and safety of extracorporeal shock wave lithotripsy or pneumatic ureteroscopic lithotripsy for lower ureteral stones therapy, we sought to identify and summarize randomized controlled trials that were used to treat distal ureteral stone. Methods: Eligible studies were identified from electronic databases. Database search, quality assessment, and data extraction were performed by two reviewers independently. Our primary outcome was the stone-free rate. Secondary outcomes were the fragmentation rate, complications and the rate of re-treatment and secondary procedures. The results were assessed by Review Manager 5.0. Publication bias was evaluated by Stata 11.0. Results: 13 trials were included. Meta-analysis of pooled data showed that pneumatic ureteroscopic lithotripsy demonstrated a significant advantage over extracorporeal shock wave lithotripsy (OR = 0.14, 95% CI [0.09, 0.23], P < 0.00001) in the stone-free rate; the extracorporeal shock wave lithotripsy had statistical disadvantages over pneumatic ureteroscopic lithotripsy in the fragmentation rate of ureteral stones (OR = 0.14, 95% CI [0.05, 0.39], P = 0.0002); and the rate of re-treatment and secondary procedure was lower in pneumatic ureteroscopic lithotripsy than in extracorporeal shock wave lithotripsy (OR = 5.37, 95% CI [2.61, 11.07], P < 0.00001). Our pooled results showed that there was no statistical difference between extracorporeal shock wave lithotripsy and pneumatic ureteroscopic lithotripsy in hematuresis, ureteral stricture and urosepsis or fever. Finally extracorporeal shock wave lithotripsy had a higher incidence of colic pain than pneumatic ureteroscopic lithotripsy. Conclusion: The present meta-analysis suggested that pneumatic ureteroscopic lithotripsy had large advantages over extracorporeal shock wave lithotripsy in the treatment of lower ureteral stones.

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T. Li, S. Fu, X. Ming, L. Yang, J. Cheng and Z. Wang, "Efficacy of Extracorporeal Shock Wave Lithotripsy (ESWL) versus Pneumatic Ureteroscopic Lithotripsy (URSL) for Lower Ureteral Stones Therapy in Asia: A Meta-Analysis," International Journal of Clinical Medicine, Vol. 5 No. 1, 2014, pp. 4-11. doi: 10.4236/ijcm.2014.51002.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] M. Y. Zhang, S. T. Ding, J. J. Lv, et al., “Comparison of Tamsulosin with Extracorporeal Shock Wave Lithotripsy in Treating Distal Ureteral Stones,” Chinese Medical Journal (English), Vol. 122, No. 7, 2009, pp. 798-801.
[2] M. J. Bader, B. Eisner, F. Porpiglia, et al., “Contemporary Management of Ureteral Stones,” European Urology, Vol. 61, No. 4, 2012, pp. 764-772.
[3] C. Chaussy, J. Schuller, E. Schmiedt, H. Brandl, D. Jocham and B. Liedl, “Extracorporeal Shock-Wave Lithotripsy (ESWL) for Treatment of Urolithiasis,” Urology, Vol. 23, No. 5, 1984, pp. 59-66.
[4] M. L. Paik, M. A. Wainstein, J. P. Spirnak, et al., “Current Indications for Open Stone Surgery in the Treatment of Renal and Ureteral Calculi,” The Journal of Urology, Vol. 159, No. 2, 1998, pp. 374-378.
[5] I. Gecit, S. Kavak, E. K. Oguz, et al., “Lithotripsy Tissue Damage in Kidney, Adrenal Glands and Diaphragm Following Extracorporeal Shock Wave,” Toxicol Ind Health, 2012. http://dx.doi.org/10.1177/0748233712462481
[6] A. Skolarikos, G. Alivizatos and J. de la Rosette, “Extracorporeal Shock Wave Lithotripsy 25 Years Later: Complications and Their Prevention,” European Urology, Vol. 50, No. 5, 2006, pp. 981-990.
[7] P. Larcher, O. De Cobelli, L. Carmignani, et al., “Prognostic Parameters in Extracorporeal Lithotripsy,” Archivio Italiano di Urologia, Nefrologia, Andrologia: Organo Ufficiale dell’Associazione per la Ricerca in Urologia, Vol. 61, No. 4, 1989, pp. 361-364.
[8] R. J. Leveillee and L. Lobik, “Intracorporeal Lithotripsy: Which Modality Is Best?” Current Opinion in Urology, Vol. 13, No. 3, 2003, pp. 249-253.
[9] L. Tunc, B. Kupeli, C. Senocak, T. Alkibay, S. Sözen, U. Karaoglan, et al., “Pneumatic Lithotripsy for Large Ureteral Stones: Is It the First Line Treatment?” International Urology and Nephrology, Vol. 39, No. 3, 2007, pp. 759-764. http://dx.doi.org/10.1007/s11255-006-9084-7
[10] G.-Q. Zeng, W.-D. Zhong, Y.-B. Cai, et al., “Extracorporeal Shock-Wave versus Pneumatic Ureteroscopic Lithotripsy in Treatment of Lower Ureteral Calculi,” Asian Journal of Andrology, Vol. 4, No. 4, 2002, pp. 303-305.
[11] M. Islam and A. Malik, “Ureteroscopic Pneumatic versus Extracorporeal Shock Wave Lithotripsy for Lower Ureteral Stones,” J Coll Physicians Surg Pak., Vol. 22, No. 7, 2012, pp. 444-447.
[12] G. Wang, M. F. Chen, L. Wang, et al., “Comparison of the Efficacy and Side Effects of Pland Eswl in Treating Distal Ureteral Calculi,” Modern Hospital, Vol. 9, No. 3, 2009, pp. 34-35.
[13] S. R. El-Faqih, I. Husain, P. E. Ekman, et al., “Primary Choice of Intervention for Distal Ureteric Stone: Ureteroscopy or ESWL?” British Journal of Urology, Vol. 62, No. 1, 1988, pp. 13-18.
[14] M. S. Pearle, R. Nadler, E. Bercowsky, et al., “Prospective Randomized Trial Comparing Shock Wave Lithotripsy and Ureteroscopy for Management of Distal Ureteral Calculi,” The Journal of Urology, Vol. 166, No. 4, 2001, pp. 1255-1260.
[15] J. Higgins and S. Green, “Cochrane Handbook for Systematic Reviews of Interventions, Version 5.0.2,” The Cochrane Collaboration, 2009, pp. 149-190.
[16] B. Küpeli, T. Alkibay, Z. Sinik, et al., “What Is the Optimal Treatment for Lower Ureteral Stones Larger than 1 cm?” International Journal of Urology, Vol. 7, No. 5, 2000, pp. 167-171.
[17] Y. Ding, Y. Q. Gu and P. P. Qian, “Comparison of Ureteroscopic Pneumatic Lithotripsy and Extracorporeal Shock-Wave Lithotripsy for Middle and Lower Ureteral Calculi,” China Modern Doctor, Vol. 48, No. 35, 2010, pp. 127-128.
[18] X. Y. Dong, H. T. Zhao, Y. X. Wang, et al., “Comparison of Ureteroscopy Pneumatic Lithotripsy and ESWL in the Treatment of Distal Ureteral Calculi,” Journal of University, Vol. 5, No. 2, 2006, pp. 43-46.
[19] Y. M. Jin, P. Li and Z. Y. Deng, “Comparison between Effectiveness of Lower and Middle Ureteric Calculi Treated by ESWL and That by TUPL,” China Medical Engineering, Vol. 12, No. 6, 2004, pp. 78-82.
[20] L. Xie, X. Y. Yu, W. J. Li, et al., “Comparison of Ureteroscopy Pneumatic Lithotripsy and Extracorporeal Shock Wave Lithotripsy in the Treatment of Distal Ureteral Calculi,” Chinese Journal of Primary Medicine and Pharmacy, Vol. 13, No. 6, 2006, pp. 910-911.
[21] L. Wang, Y. Wang and T. Li, “A Comparative Study on ESWL and Ureteoslopic Pneumatic Lithotripsy for Ureteral Stones,” Hebei Medical Journal, Vol. 24, No. 11, 2002, pp. 886-887.
[22] J. Zhang, G. Z. Wang, N. Jiang, et al., “Comparison of Three Procedures for Treatment of Ureteral Calculus,” Journal of Bengbu Medical College, Vol. 34, No. 2, 2009, pp. 140-142.
[23] W. X. Zhang, S. D. Yang, H. B. Zhang, et al., “Comparison of Emergency Ureteroscopic Lithotripsy and Extracorporeal Shock Wave Lithotripay in the Treatment of Ureteral Stones with Acute Renal Colic,” China Medcine and Pharmacy, Vol. 2, No. 9, 2012, pp. 73-75.
[24] L. Y. Li, Z. X. Tao, L. Luo, et al., “Comparison of Ureteroscopic Pneumatic Lithotripsy and Extracorporeal Shock-Wave Lithotripay for Ureteric Calculi,” Journal of Clinical Urology, Vol. 20, No. 6, 2005, pp. 326-330.
[25] Y. Q. Wu, L. J. Wu and G. Q. Chen, “Comparison the Efficacy of Middle and Lower Ureteric Calculus Treated by URL and ESWL,” China Modern Doctor, Vol. 49, No. 29, 2011, pp. 36-37.
[26] G. M. Preminger, H. G. Tiselius, D. G. Assimos, et al., from American Urological Association Education and Research, Inc.; European Association of Urology, “2007 Guideline for the Management of Ureteral Calculi,” European Urology, Vol. 52, No. 6, 2007, pp. 1610-1631.
[27] A. Kose and M. Demirbas, “The ‘Modified-Prone Position’: A New Approach for Treating Prevesical Stones with Extracorporeal Shock Wave Lithotripsy,” BJU International, Vol. 93, No. 3, 2004, pp. 369-373.
[28] M. Demirbas, A. C. Kose, M. Samli, et al., “Extracorporeal Shockwave Lithotripsy for Solitary Distal Ureteral Stones: Does the Degree of Urinary Obstruction Affect Success?” Journal of Endourology, Vol. 18, No. 3, 2004, pp. 237-240.
[29] F. J. Anglada-Curado, P. Campos-Hernández, J. Carrasco-Valiente, et al., “Extracorporeal Shock Wave Lithotripsy for Distal Ureteral Calculi: Improved Efficacy Using Low Frequency,” International Journal of Urology, Vol. 20, No. 2, 2012, pp. 214-219.
[30] M. Egger, G. D. Smith and M. Schneider, “Systematic Reviews of Observational Studies,” In: M. Egger, G. D. Smith and D. G. Altman, Eds., Systematic Reviews in Healthcare Meta-Analysis in Context, BMJ Publishing, London, 2001, pp. 211-227.

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