ObjectiveTo investigate the outcomes of ureteroscopy and lasertripsy in lower pole renal stones <2 cm when treated in situ compared to displacement to the upper pole.Patients and MethodsUsing the Medical Literature Analysis and Retrieval System Online (MEDLINE)/PubMed, the Excerpta Medica dataBASE (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, and Clinicaltrials.gov we identified adult population, English language, studies published until March 2023 comparing surgical outcomes and stone‐free rates (SFRs) in relation to lower pole stones <2 cm managed in situ vs those displaced (International Prospective Register of Systematic Reviews [PROSPERO] identifier: CRD42023432750). Analysis was performed using R with the ‘meta’ package. Bias analysis was performed using the Cochrane Risk of Bias 2 tool for randomised trials and the Newcastle–Ottawa scale for observational studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to ascertain the certainty of evidence.ResultsA total of five studies were included, comprising two retrospective cohort studies, three randomised trials, with a total of 408 patients. Meta‐analysis demonstrated SFRs are significantly higher in those patients undergoing displacement vs those managed in situ (risk ratio 1.21, 95% confidence interval [CI] 1.10–1.34, P < 0.001). There was no significant difference in complication rates. Operative time was significantly longer in the displacement group (mean difference 5.62 min, 95% CI 0.40–10.83 min; P = 0.03). Overall risk of bias was moderate. Certainty of evidence was moderate for stone‐free status, and very low for all other outcomes.ConclusionsThis systematic review and meta‐analysis demonstrates that for lower pole stones <2 cm displacement strategies have significantly higher SFRs than treatment in situ, with no significant difference in complications. There is significantly increased operative time in the displaced group, but an additional 6 min is unlikely to be clinically significant.

中文翻译：

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输尿管镜检查和激光切开术治疗下极结石 <2 cm，原位与移位？系统评价和荟萃分析


目的探讨输尿管镜和激光注射术对下极肾结石 <2 cm 原位治疗与移位至上极肾结石的结局。患者和方法使用在线医学文献分析和检索系统 （MEDLINE）/PubMed、摘录医学数据库 （EMBASE）、护理和相关健康文献累积索引 （CINAHL）、Cochrane 图书馆和 Clinicaltrials.gov 我们确定了成年人群、英语、截至 2023 年 3 月发表的研究，比较了手术结果和结石清除率 （SFR） 与原位管理的下极结石 <2 cm 与移位者的关系（国际前瞻性系统综述注册 [PROSPERO] 标识符：CRD42023432750）。使用带有 'meta' 包的 R 进行分析。随机试验使用 Cochrane Risk of Bias 2 工具进行偏倚分析，观察性研究使用 Newcastle-Ottawa 量表进行偏倚分析。使用建议分级、评估、开发和评价 （GRADE） 方法来确定证据的质量。结果共纳入 5 项研究，包括 2 项回顾性队列研究、3 项随机试验，共 408 名患者。荟萃分析显示，与原位治疗的患者相比，接受移位的患者的 SFR 显着更高 （风险比 1.21,95% 置信区间 [CI] 1.10-1.34，P < 0.001）。并发症发生率无显著差异。置换组手术时间显著延长（平均差 5.62 min，95% CI 0.40-10.83 min;P = 0.03）。总体偏倚风险为中等。无结石状态的证据质量为中等，所有其他结局的证据质量为极低。结论本系统评价和荟萃分析表明，对于下极结石，<2 cm 移位策略的 SFR 明显高于原位治疗，并发症无显著差异。移位组的手术时间显著增加，但额外的 6 分钟不太可能具有临床意义。