A Meta-analysis Of Holmium Laser Lithotripsy And Pneumatic Lithotripsy Treat Ureteralstone Efficiency

Objective:To compare the holmium laser lithotripsy and pneumatic lithotripsy. To access theefficacy and safety of holmium laser treatment of ureteral stones and provide theevidence for the clinical treatment.Methods：We searched Pubmed, The Cochrane Library, CNKI, CVIP databases from1993to2011and hand searching of relevant Journal of Urology. The quality of trials wasevaluated and meta-analysis was performed. None-randomized controlled trials we realso included to evaluate the safety and efficacy.Observed indicators include;①E valuation indicators during hospitalization include: Single operationstonefragmentation information,operation time, hospital stay, postoperative stone free rate.②complications indicators include: intraoperative ureteral mucosal avulsion rate, theincidence of intraoperative ureteral perforation, the incidence of postoperative fever,persistent postoperative bleeding rate.Result:We found6randomized controlled trials. A total of599participants we are in the trials, theresult of Meta analysis indicates: Evaluation indictors during hospitalization, including: singleoperation stone fragmentation information, operation time, hospital stay, postoperative stone freerate. Comparing two single-operation success rate of stone fragmentationinformation:{RR=1.26,95%CI(1.16,1.38),Z=5.31， P<0.00001},HL has higher success rate.Compared hospital stay:{Total WMD=-0.25,95%CI(-0.91,0.41),Z=0.75，P=0.45，}Two groupsstay of time has no significant difference in statistics. Compared the operation time Total{WMD=-5.98,95%C（I-11.01，-0.94），Z=2.33,P=0.2}，Operation time by HL is shorter. Comparedthe postoperative stone free rate:{RR=1.28,95%CI(0.66,2.48)Z=0.73，P=0.47}, twogroups’ rate has no significant difference in statistics. complications indicators include: intraoperative ureteral mucosal avulsion rate, the incidence of intraoperative ureteral perforation,the incidence of postoperative fever, persistent postoperative bleeding rate Compared theintraoperative ureteral mucosal avulsion rate:{RR=1.02，95%CI (0.19,5.37),Z=0.03，P=0.98}, twogroups’ rate has no significant difference in statistics.Compared the incidence of intraoperativeureteral perforation:{RR=1.10,95%CI (0.32,3.77),Z=0.16，P=0.87}, two groups’ rate has nosignificant difference in statistics. Compared persistent postoperative bleedingrate:{RR=0.77,95%CI(0.13,4.42),Z=0.30.P=0.77}，two groups’ rate has no significant differencein statistics.Coclcusions:Meta analysis indicates that Treat the ureteral stones by HL and PL has followingfeatures:1.HL has higher single-operation success rate of stone fragmentation，2.HLoperation time is shorter，3.There is no significant difference among hospital stay,postoperative stone free rate,4.Fever rate after HL is lower,There is no significantdifference among intraoperative ureteral mucosal avulsion rate, the incidence ofintraoperative ureteral perforation and persistent postoperative bleeding rate。Compared with PL, HL is more safe and efficacy, With more randomized control dataand longer follow-up data come out, its high efficiency will be further reflected.