Effectiveness And Safety Of Extracorporeal Shock Wave Lithotripsy Combined With Diuretics In The Treatment Of Urolithiasis:A Meta-analysis

Objective:Urolithiasis is one of the most common diseases in the Department of Urology at home and abroad.In recent years,the incidence and recurrence rate of calculi have been increasing gradually.With the continuous development of medicine,the minimally invasive lithotripsy represented by extracorporeal shock wave lithotripsy(ESWL)has brought great changes in the treatment of calculi.Currently,many studies have investigated the application of diuretics in the ESWL,but their conclusions are different.Therefore,this study has used meta-analysis to further explore the efficacy of ESWL in combination with diuretics in order to provide a reliable basis for the clinical treatment.Methods:Published randomised controlled trials of ESWL in combination with diuretics in the treatment of patients with calculi were reviewed via computer retrieval of PubMed,Embase,Cochrane Library,CNKI,Wanfang,VIP and CBM from their establishment to January 01,2020,as well as supplemented by manual retrieval of references included in the literature.Two investigators independently screened the literature,extracted the data,evaluated the risk of research bias,and cross-checked the results.Meta-analysis was carried out using RevMan 5.3 and Stata 12.0 software.Subgroup analysis was used to find out the heterogeneous sources or explore the influence of different factors on the overall results.The sensitivity analysis was used to discover the heterogeneous sources and discuss the stability of conclusions.The funnel plots,Egger regression analysis and Begg rank correlation method were used to detect the publication bias.Results:This meta-analysis has eventually included 12 articles involving a total of 3,355 patients.The results showed that:when compared to the conventional ESWL treatment,the ESWL in combination with diuretics increased the post-treatment stone clearance rate[RR=1.18,95%CI(1.12,1.24),p<0.00001],stone breakage rate[RR=1.12,95%CI(1.02,1.21),p=0.01]and pain relief rate[RR=1.41,95%CI(1.26,1.57),p<0.00001].In terms of complications[RR=1.05,95%CI(0.57,1.94),p=0.87]and number of treatments[RR=-0.14,95%CI(-0.31,0.03),p=0.11],the difference was not statistically significant.The results of subgroup analysis showed that when compared to the conventional ESWL treatment,the ESWL in combination with diuretics could improve the clearance of kidney stones,upper ureteral and lower ureteral calculi.The difference in the clearance of middle ureteral calculi was not statistically significant between the two methods.Either preoperative or postoperative use of diuretics and diuresis can improve the stone clearance rate with or without combined fluid infusion.Conclusion:Current evidence shows that the ESWL in combination with diuretics is safe and effective in the treatment of urinary calculi.Due to the small number of included studies and uneven quality levels,more large sample and multi-center high-quality studies are needed to further validate the above conclusions.