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Inicio Actas Urológicas Españolas (English Edition) Is extracorporeal shock wave lithotripsy a current treatment for urolithiasis? A...
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Vol. 41. Issue 7.
Pages 426-434 (September 2017)
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Vol. 41. Issue 7.
Pages 426-434 (September 2017)
Review article
DOI: 10.1016/j.acuroe.2017.01.001
Is extracorporeal shock wave lithotripsy a current treatment for urolithiasis? A systematic review
¿Es la litotricia extracorpórea por ondas de choque en la actualidad un tratamiento vigente para el tratamiento de la litiasis urinaria? Revisión sistemática
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P. Bahílo Mateua,
Corresponding author
pilarbahilo@hotmail.com

Corresponding author.
, A. Budía Albaa, E. Liatsikosb, M. Trassierra Villaa, J.D. López-Acóna, D. de Guzmán Ordaza, F. Boronat Tormoa
a Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
b Universidad de Patras, Patras, Greece
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Tables (7)
Table 1. Characteristics of the studies on renal lithiases.
Table 2. Characteristics of the studies on ureteral lithiases.
Table 3. Lithiasis-free rate (LFR) according to the time evaluated.
Table 4. Percentage of total complications according to different studies.
Table 5. Rate free of lithiasis in the treatment of lithiasis in proximal ureter according to different studies.
Table 6. Percentage of total complications according to different studies.
Table 7. Percentage of free rate of lithiasis and complications in the treatment of urinary lithiasis by extracorporeal lithotripsy at 3 months of intervention according to different studies.
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Abstract
Introduction

Technological advances have prompted a change in the management of urolithiasis. Endourological techniques are gaining importance because they are highly effective treatments. The aim of this study was to answer the question of whether extracorporeal shock wave lithotripsy (ESWL) is still a competitive alternative compared with other therapeutic modalities.

Acquisition of evidence

We conducted a literature search of articles published in the past 5 years. We identified 12 randomized and comparative studies and assessed the methodology and results of the study variables. We performed a narrative synthesis of the included studies. To summarize the variables, we used the mean and standard deviation for continuous variables and absolute numbers and percentages for the qualitative variables.

Analysis of the evidence

Of the studies reviewed, 7 evaluated the various treatments for nephrolithiasis and 5 evaluated the treatments for ureteral lithiasis. At the renal level, a stone-free rate of 33.33–91.5% at 3 months was reached with ESWL, while a rate of 90.4–100% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. At the ureteral level, a stone-free rate of 73.5–82.2% at 3 months was reached with ESWL, while a rate of 79–94.1% was achieved with the other endourological techniques, without finding statistically significant differences in the studies.

Conclusion

There is a lack of homogeneity among the published studies. ESWL is a minimally invasive treatment that with an appropriate technique and patient selection achieves high effectiveness, thus maintaining an important role at this time.

Keywords:
Lithiasis
Extracorporeal lithotripsy
Endourology
Treatment
Resumen
Introducción

Los avances tecnológicos han motivado un cambio en el manejo de la urolitiasis. Las técnicas endourológicas están cobrando mayor importancia, ya que son tratamientos altamente eficaces. El objetivo de este trabajo es responder a la cuestión de si la LEOCH sigue siendo una alternativa competitiva frente a otras modalidades terapéuticas.

Adquisición de la evidencia

Se realizó una búsqueda bibliográfica de artículos publicados en los últimos 5 años. Fueron identificados 12 estudios aleatorizados y comparativos. Se evaluó la metodología y el resultado de las variables estudiadas. Se ha realizado una síntesis narrativa de los estudios incluidos. Para resumir las variables se ha utilizado la media y la desviación estándar en variables continuas, y para variables cualitativas el número absoluto y el porcentaje.

Análisis de la evidencia

De los estudios revisados, 7 trabajos evaluaban los distintos tratamientos para litiasis renales y 5 para litiasis ureterales. A nivel renal, con LEOCH se alcanza una TLL a los 3 meses entre 91,5-33,33%, mientras que con otras técnicas endourológicas entre 100-90,4%, sin encontrar diferencias estadísticamente significativas en todos los estudios. A nivel ureteral con LEOCH se alcanza una TLL a los 3 meses entre 82,2-73,5%, mientras que con otras técnicas endourológicas entre 94,1-79%, sin encontrar diferencias estadísticamente significativas todos los estudios.

Conclusión

Existe una falta de homogeneidad entre los estudios publicados. La LEOCH es un tratamiento mínimamente invasivo, que con una adecuada técnica y selección del paciente alcanza una elevada efectividad, manteniendo un papel importante en la actualidad.

Palabras clave:
Litiasis
Litotricia extracorpórea
Endourología
Tratamiento

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