LAUSR

Hopefully, the result of this study might help urologists to choose an optimal approach. METHODS: A systematic review and network meta-analysis were undertaken to assess the efficacy of various treatments by searching published randomized controlled trials from electronic databases PubMed, Embase, and the Cochrane Library up to December, 2018. The major efficacy outcomes were stone free rate, re-treatment rate and auxiliary procedure rate. The adverse effect outcome was Clavien grade 3 complications. RESULTS: A total of 19 randomized control trials with 2485 patients were included in this study. Five different treatments were evaluated: extracorporeal shock wave lithotripsy (ESWL), retrograde renal surgery (RIRS), percutaneous nephrolithotomy (PCNL), miniperc and microperc. Compared to ESWL, the other 4 treatments provided significantly higher stone free rate. In addition, the surface under the cumulative ranking curve (SUCRA) analysis for stone free rate (SFR) showed that miniperc was ranked best, followed by PCNL, microperc, RIRS and ESWL. No significant differences in Clavien grade 3 complication rate were evident between the treatments. The SUCRA analysis of SFR in patients with lower calyx stones of 10-20mm showed that miniperc was ranked best, followed by PCNL, RIRS and ESWL. CONCLUSIONS: Miniperc seems to be the most effective treatment for patients with kidney stone <2 cm. Subgroup analysis of 10-20mm lower calyx stones also suggested miniperc was associated with the highest SFR.