Review – Stone DiseaseTreatment of Bladder Stones in Adults and Children: A Systematic Review and Meta-analysis on Behalf of the European Association of Urology Urolithiasis Guideline Panel☆
Introduction
Despite constituting only approximately 5% of all urinary tract stones [1], bladder stones (BSs) are responsible for 14% of hospital admissions [2] and 8% of urolithiasis-related deaths in developed nations [3]. BSs are more prevalent in men and in developing countries 3, 4, 5. BSs have a bimodal age distribution: incidence peaks at 3 4, 6 and 60 yr [4]. BSs may cause lower urinary tract symptoms, infections, pain, and haematuria, and have been associated with bladder cancer [8].
BSs can be classified as primary, secondary, and migratory [9]. Primary or endemic BSs occur in the absence of other urinary tract pathologies, typically seen in children in areas with a diet lacking animal protein, poor hydration, and recurrent diarrhoea [10]. Secondary BSs occur in the presence of other urinary tract abnormalities, including bladder outlet obstruction, neurogenic bladder dysfunction, chronic bacteriuria, foreign bodies including catheters, bladder diverticulae, and bladder augmentation or urinary diversion. Migratory BSs form in the upper urinary tract [9].
Although open cystolithotomy (CL) is the traditionally accepted treatment modality [8], minimally invasive treatments have widely been adopted to reduce hospital stay and convalescence. However, it is unclear whether these treatments may compromise stone-free rates (SFRs) and what morbidity they may expose patients to 7, 8. We present the first systematic review that addresses benefits and harms of procedures used to remove BSs in either adults or children.
Section snippets
Search strategy
We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement [11] and the Cochrane Handbook for Systematic Reviews of Interventions [12]. Medline, Embase, and Cochrane controlled trials databases and clinicaltrial.gov were searched between January 1970 and February 2019 for relevant English-language publications.
The published a priori protocol includes the search strategy [13]. Following deduplication, two review
Description of the included studies
A total of 2742 abstracts were screened and 59 full-text articles were assessed: 27 articles on 25 studies were included with 2340 patients: 1526 adults and 814 children. Reasons for exclusion are listed in Fig. 1.
Study characteristics
Characteristics of the included studies are listed in Supplementary Table 1. Twenty studies on adults were included: nine RCTs and 11 NRSs; two studies compared four interventions, and four studies compared three interventions. Five studies in children were included: one RCT and four
Discussion
This study provides the first ever systematic review and meta-analyses on the treatment of BSs, and has informed the first national or international guideline on BSs [41]. Complete removal of a stone constitutes the most important outcome when evaluating the efficacy of any stone treatment. Our results indicate that SWL was less effective than endoscopic or open surgery in both adults and children in terms of SFR, although the QoE was low or very low. An RCT on small (<2 cm) BSs in adults found
Conclusions
This systematic review demonstrates that endoscopic, transurethral, and percutaneous BS treatments are associated with comparable SFRs, but with a shorter operation and catheterisation duration as well as a shorter length of hospital stay, compared with open CL, in both adults and children. SWL appears to offer an inferior SFR when compared with other procedures, but offers the shortest duration of hospital stay. In adults, TUCL using an instrument with continuous flow (eg, a nephroscope or a
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Treatment outcomes of bladder stones in children with intact bladders in developing countries: A systematic review of >1000 cases on behalf of the European Association of Urology Bladder Stones Guideline panel
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