NS-AUA 2024 Annual Meeting Abstracts – Endourology, Stones

Introduction: Extracorporeal shockwave lithotripsy (ESWL) is a common procedure for the management of renal stones and is usually performed using fluoroscopic (FS) guidance.The usage of ultrasound (US) guidance is emerging as an alternative with the benefit of minimizing exposure to radiation.We aimed to compare the efficacy and safety of US and FS-guided ESWL.Thus, stone-free rates (SFR) and overall complication rates were our primary outcomes, and secondary outcomes were re-intervention rates and individual complication rates, such as urinary tract infection (UTI).Methods: We conducted a systematic review with meta-analysis in adherence to PRISMA guidelines.Following Prospero protocol registration (CRD42024511335), we searched MEDLINE, EMBASE, Cochrane CENTRAL, and Web of Science from inception to February 15, 2024.The search was supplemented by snowballing techniques and a Google Scholar search for grey literature.Our search included adult and pediatric populations, and a separate subgroup analysis was conducted for each population.Results: Eleven studies were included yielding 2383 patients (US=1021, FS=1362), with eight studies (n=1737 patients) completing the adult subgroup, and three studies (n=646 patients) completing the pediatric subgroup.Patients treated with US had a 63% increased likelihood of achieving SFR status (OR=1.63;95% CI [1.23,2.16];P=0.0007,I 2 = 29%).Subgroup analysis demonstrated this difference to be only present in the adult subgroup.Complication rates were 64% less likely for adult patients exposed to US conditions (OR=0.36,95% CI [0.16,0.82],P=0.01,I 2 = 0%); however, no such difference was observed in pediatric samples.There was no difference in re-intervention rates and postoperative UTI in both ESWL approaches.Conclusions: Our analysis demonstrated that ultrasound guidance achieved superior ESWL outcomes in terms of SFR rates and complications compared to fluoroscopy-guided ESWL.However, this difference was only observed in the adult subgroup, which raises the question of age being a factor or whether there are other contributing factors.Our results should be interpreted with caution as the number of randomized controlled trials (RCTs) was limited, and heterogeneity existed between the studies.More research is needed, especially in pediatric populations, to further elucidate and confirm the benefits of US guidance in ESWL.