The comparison of totally ultrasound-guided versus fluoroscopy-guided shockwave lithotripsy in renal stone treatment: a systematic review and meta-analysis.

Extracorporeal shock wave lithotripsy (SWL) has been a well-known therapy since years ago, especially for renal stones less than 20 mm. This study compared the effectiveness of totally ultrasound-guided (US-guided) and fluoroscopy-guided (FS-guided) SWL in treating renal and ureteral stones. A protocol has been registered in PROSPERO databases for systematic reviews. A systematic literature search was conducted in five online databases (PubMed, ScienceDirect, EMBASE, ProQuest, and Scopus). We included all available articles that compared the effectiveness and safety of US-SWL to FS-SWL. A risk of bias assessment was done using Risk of Bias (Rob) Tools for randomized interventional studies and Risk of bias in non-randomized studies interventions (ROBINS-I) Tools for Non-randomized studies. The primary outcome was the stone-free rate, and the secondary outcome was the complication rate. Subgroup analyses were performed for adult and pediatric groups. A comprehensive literature search identified seven comparative articles that matched the criteria: two randomized trials and six retrospective cohort studies comprising 1,255 patients (609 using US-SWL). The results revealed a significant difference in overall stone-free rates between US-guided and FS-guided SWL RR 0.76(95% CI; 0.61-0.95, p=0.02) and in adults RR 0.76(95% CI; 0.60-0.96), but not children groups RR 0.68(95% CI; 0.24-1.88). US-SWL might be favourable due to the radiation-free procedure and real-time presentation. Complication rates were low, and no life-threatening complications were reported. In conclusion, US-guided SWL is more effective than FS-guided SWL for treating renal stones, with a low incidence of complications. Further randomized controlled trials with larger populations are needed to explore the comparison more accurately.