To evaluate the safety and efficacy of single-probe dual-energy (SPDE) lithotripters in patients undergoing percutaneous nephrolithotripsy (PCNL) through a systematic review and meta-analysis.
We searched PubMed, Cochrane Library, Scopus and Embase databases until July 2022 for any preclinical or clinical studies, exploring the safety and efficacy of different SPDE lithotripters in patients undergoing PCNL. We performed a meta-analysis to compare stone-free rate, bleeding, or other complications and mean operative time between SPDE lithotripters and other lithotripters (PROSPERO: CRD42021285631).
We included 16 studies (six preclinical, seven observational and three randomized with 625 participants) in the systematic review and four in the meta-analysis. Preclinical studies suggest that SPDE lithotripters are safe and effective for the management of renal stones. Among clinical studies, four studies assessed Trilogy with no comparative arm, two compared Trilogy or ShockPulse with a dual-probe dual-energy lithotripter, two compared Trilogy with a laser, one compared ShockPulse with a pneumatic lithotripter, and one directly compared Trilogy with ShockPulse. Comparing SPDE lithotripters to other lithotripters, no significant differences were demonstrated in stone free rate (OR 1.13, 95% CI 0.53-2.38, I2 = 0%), postoperative blood transfusion (OR 1.33, 95% CI 0.34-5.19, I2 = 0%), embolization (OR 0.45, 95% CI 0.02-12.06), operative time (WMD: 2.82 min, 95% CI -7.31-12.95, I2 = 78%) and postoperative complications based on the Clavien-Dindo classification.
SPDE lithotripters represent a promising treatment modality for patients requiring PCNL. Despite the initial encouraging findings of preclinical and isolated clinical studies, it seems that Trilogy or ShockPulse provide similar efficiency compared to older generation devices.
World journal of urology. 2023 Jan 19 [Epub ahead of print]
Ioannis Mykoniatis, Nikolaos Pyrgidis, Lazaros Tzelves, Amelia Pietropaolo, Patrick Juliebø-Jones, Vincent De Coninck, Belthangady M Zeeshan Hameed, Michael Chaloupka, Gerald Bastian Schulz, Christian Stief, Panagiotis Kallidonis, Bhaskar K Somani, Andreas Skolarikos
First Department of Urology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece., Department of Urology, University Hospital, LMU Munich, Munich-Marchioninistr. 15, 81377, Munich, Germany., Second Department of Urology, Sismanoglio Hospital, Sismanogliou 37, Athens, Greece., Department of Urology, University of Hospital Southampton NHS Trust, Southampton, UK., Department of Urology, Haukeland University Hospital, Bergen, Norway., Department of Urology, AZ Klina, Brasschaat, Belgium., Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India., Department of Urology, University of Patras, Patras, Greece., Second Department of Urology, Sismanoglio Hospital, Sismanogliou 37, Athens, Greece. .