Effectiveness of Pneumatic versus Laser Lithotripsy for Upper Tract Urolithiasis: A Systematic Review and...

This meta-analysis compares the efficacy and safety of laser lithotripsy (LL) and pneumatic lithotripsy (PL) for upper tract urolithiasis.

A systematic search of MEDLINE via PubMed, Embase, and the Cochrane Library identified trials comparing LL and PL. Primary outcomes included stone-free rate, operative time, and complications. A random-effects model was used, and heterogeneity was assessed using I2 statistics.

The systematic literature search identified 6,420 studies of which 43 fulfilled the inclusion criteria. The studies reported data from 7,377 patients. Random effect meta-analysis for stone free rate included data from 36 studies and yielded statistically significant higher stone free rates for LL with a pooled OR = 2.19 (95% confidence interval [CI] = 1.63-2.94, p < 0.001). Heterogeneity was substantial (I2 = 62%; p < 0.01). Random effect meta-analysis for operative time included data from 31 studies and yielded no statistically significant difference in operative time with a pooled MD = -1.09 min (95% CI = -4.39-2. 20, p = 0.5161). Heterogeneity was considerable (I2 = 98%; p < 0.01). Random effect meta-analysis for complications included data from 14 studies and yielded statistically significant fewer complications for LL with a pooled OR = 0.68 (95% CI = 0.48-0.96, p = 0.0276). Heterogeneity was limited (I2 = 27%; p = 0.17).

LL might be superior to PL in upper tract urolithiasis therapy.