Supine is Superior to Prone Position in Treating the Distal Ureteral Calculi During Extracorporeal Shockwave Lithotripsy: An Updated Meta-Analysis Supine versus prone position for UC
Urology Journal,
Vol. 19 No. 01 (2022),
18 March 2022
,
Page 9-16
https://doi.org/10.22037/uj.v19i01.6946
Abstract
Purpose: Although extracorporeal shockwave lithotripsy (SWL) has been confirmed to be effective in treating ureteral stone, a definitive conclusion on which patient’s position is the optimal option during SWL treatment remains unclear. We, therefore, performed this updated meta-analysis to further clarify it.
Materials and Methods: PubMed, Embase, and Cochrane library were performed to capture all potentially eligible studies from their inception to October 2020. After screening eligible studies, extracting essential data, and assessing the risk of bias, we used STATA 14.0 to complete all statistical analyses.
Results: We included 7 studies involving 8 cohorts in the final analysis. Our meta-analysis suggested that the prone position was inferior to the supine position in terms of stone fragmentation and stone clearance rate after completing the first treatment (95% CI: 0.30-0.63; OR = 0.44;), however, subgroup analysis indicated that the difference between supine and prone positions for stone fragmentation and the stone clearance rate was only getting statistical significance for distal ureteral stone (95% CI: 0.23-0.53; OR = 0.35). Moreover, subgroup analysis of two eligible randomized controlled trials suggested that the mean number of sessions per patient in the supine group was less than that in the prone group (95% CI: 0.11-0.48; WMD = 0.294). No major and severe complication was detected to be done with the association with positions.
Conclusion: SWL of the supine position may be the preferred option because this strategy can increase the distal ureteral stone-free rate compared to the prone position.
- Ureteral calculi
- extracorporeal shockwave lithotripsy
- supine position
- prone position
- meta-analysis
How to Cite
References
Tiselius HG, Chaussy CG. Aspects on how extracorporeal shockwave lithotripsy should be carried out in order to be maximally effective. Urol Res. 2012;40:433-46.
Assimos D, Krambeck A, Miller NL, et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART I. J Urol. 2016;196:1153-60.
Tzelves L, Türk C, Skolarikos A. European Association of Urology Urolithiasis Guidelines: Where Are We Going? Eur Urol Focus. 2020.
Segura JW, Preminger GM, Assimos DG, et al. Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi. The American Urological Association. J Urol. 1997;158:1915-21.
Semins MJ, Matlaga BR. Strategies to optimize shock wave lithotripsy outcome: Patient selection and treatment parameters. World J Nephrol. 2015;4:230-4.
Hara N, Koike H, Bilim V, Takahashi K, Nishiyama T. Efficacy of extracorporeal shockwave lithotripsy with patients rotated supine or rotated prone for treating ureteral stones: a case-control study. J Endourol. 2006;20:170-4.
Jenkins AD, Gillenwater JY. Extracorporeal shock wave lithotripsy in the prone position: treatment of stones in the distal ureter or anomalous kidney. J Urol. 1988;139:911-5.
Phipps S, Stephenson C, Tolley D. Extracorporeal shockwave lithotripsy to distal ureteric stones: the transgluteal approach significantly increases stone-free rates. BJU Int. 2013;112:E129-33.
Kamel M, Salem EA, Maarouf A, Abdalla M, Ragab A, Shahin AM. Supine transgluteal vs prone position in extracorporeal shock wave lithotripsy of distal ureteric stones. Urology. 2015;85:51-4.
Köse AC, Demirbas M. The 'modified prone position': a new approach for treating pre-vesical stones with extracorporeal shock wave lithotripsy. BJU Int. 2004;93:369-73.
Galli R, Sighinolfi MC, Micali S, et al. Advantages of the supine transgluteal approach for distal ureteral stone extracorporeal shock wave lithotripsy: outcomes based on CT characteristics. Minerva Urol Nefrol. 2017;69:189-94.
Li T, Gao L, Chen P, et al. Supine versus Prone Position during Extracorporeal Shockwave Lithotripsy for Treating Distal Ureteral Calculi: A Systematic Review and Meta-Analysis. Urol Int. 2016;97:1-7.
Higgins JPT, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019. Available from www.training.cochrane.org/handbook.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62:1006-12.
Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.handbook.cochrane.org.
Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.
Fang CL, Huang H, Xu ZJ. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies. PLOS ONE. Dataset. https://doi.org/10.1371/journal.pone.0154716.t002 2016.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539-58.
Bowden J, Tierney JF, Copas AJ, Burdett S. Quantifying, displaying and accounting for heterogeneity in the meta-analysis of RCTs using standard and generalised Q statistics. BMC Med Res Methodol. 2011;11:41.
Page MJ, McKenzie JE, Higgins JPT. Tools for assessing risk of reporting biases in studies and syntheses of studies: a systematic review. BMJ Open. 2018;8:e019703.
Palma Perez S, Delgado Rodriguez M. Practical considerations on detection of publication bias. Gac Sanit. 2006;20 Suppl 3:10-6.
Choo MS, Han JH, Kim JK, et al. The transgluteal approach to shockwave lithotripsy to treat distal ureter stones: a prospective, randomized, and multicenter study. World J Urol. 2018;36:1299-306.
Göktaş S, Peşkircioğlu L, Tahmaz L, Kibar Y, Erduran D, Harmankaya C. Is there significance of the choice of prone versus supine position in the treatment of proximal ureter stones with extracorporeal shock wave lithotripsy? Eur Urol. 2000;38:618-20.
Istanbulluoglu MO, Hoscan MB, Tekin MI, Cicek T, Ozturk B, Ozkardes H. Shock wave lithotripsy for distal ureteric stones: supine or prone. Urol Res. 2011;39:177-80.
Zomorrodi A, Elahian A, Ghorbani N, Tavoosi A. Comparison of the effect of body position, prone or supine, on the result of extracorpreal shock wave lithotripsy in patients with stones in the proximal ureter. Saudi J Kidney Dis Transpl. 2007;18:200-5.
Tiselius HG, Ackermann D, Alken P, Buck C, Conort P, Gallucci M. Guidelines on urolithiasis. Eur Urol. 2001;40:362-71.
Rose VL. American Urological Association recommends observation for the majority of cases of ureteral calculi. Am Fam Physician. 1998;57:862, 7-8.
Ng CF, Tolley D. Lithotripsy for ureteric stones: throw away the ureteroscope. BJU Int. 2003;92:1045-6.
Lu J, Sun X, He L. Sciaticum majus foramen and sciaticum minus foramen as the path of SWL in the supine position to treat distal ureteral stone. Urol Res. 2010;38:417-20.
- Abstract Viewed: 124 times
- 6946/pdf Downloaded: 98 times