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      Does previous unsuccessful shockwave lithotripsy influence the outcomes of ureteroscopy?—a systematic review and meta-analysis

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          Abstract

          Background

          To determine whether previous unsuccessful shockwave lithotripsy (SWL) influence the outcomes of ureteroscopy (URS).

          Methods

          An exhaustive search of PubMed, EMBASE, Web of Science and Cochrane Library were conducted to find eligible studies before October 2020. Result variables consisting stone-free rate (SFR), operation time and postoperative modified Clavien grade I-IV complications were pooled utilizing RevMan 5.3.

          Results

          Seven studies with 2413 individuals were included. Pooled results revealed that the salvage URS after failed SWL was similar to URS performed primarily regarding SFR [odds ratio (OR) =0.84, P=0.15] and operation time [weighted mean difference (WMD) =6.79, P=0.19]. Additionally, no statistically significant differences concerning fever (OR: 1.36; P=0.32), hematuria (OR: 0.81; P=0.75), urinary tract infection (OR: 1.57; P=0.28), renal colic (OR: 1.94; P=0.50), ureteral perforation (OR: 1.44; P=0.46), ureteral avulsion (OR: 1.21; P=0.83), stone migration (OR: 0.92; P=0.86) and sepsis (OR: 0.46; P=0.38) were observed between salvage URS and primary URS group.

          Discussion

          The success rates and complications of URS were not impacted by previous unsuccessful SWL. The salvage URS is equally effective and safe to primary URS.

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          Most cited references28

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          ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions

          Non-randomised studies of the effects of interventions are critical to many areas of healthcare evaluation, but their results may be biased. It is therefore important to understand and appraise their strengths and weaknesses. We developed ROBINS-I (“Risk Of Bias In Non-randomised Studies - of Interventions”), a new tool for evaluating risk of bias in estimates of the comparative effectiveness (harm or benefit) of interventions from studies that did not use randomisation to allocate units (individuals or clusters of individuals) to comparison groups. The tool will be particularly useful to those undertaking systematic reviews that include non-randomised studies.
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            Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.

            Although quality assessment is gaining increasing attention, there is still no consensus on how to define and grade postoperative complications. This shortcoming hampers comparison of outcome data among different centers and therapies and over time. A classification of complications published by one of the authors in 1992 was critically re-evaluated and modified to increase its accuracy and its acceptability in the surgical community. Modifications mainly focused on the manner of reporting life-threatening and permanently disabling complications. The new grading system still mostly relies on the therapy used to treat the complication. The classification was tested in a cohort of 6336 patients who underwent elective general surgery at our institution. The reproducibility and personal judgment of the classification were evaluated through an international survey with 2 questionnaires sent to 10 surgical centers worldwide. The new ranking system significantly correlated with complexity of surgery (P < 0.0001) as well as with the length of the hospital stay (P < 0.0001). A total of 144 surgeons from 10 different centers around the world and at different levels of training returned the survey. Ninety percent of the case presentations were correctly graded. The classification was considered to be simple (92% of the respondents), reproducible (91%), logical (92%), useful (90%), and comprehensive (89%). The answers of both questionnaires were not dependent on the origin of the reply and the level of training of the surgeons. The new complication classification appears reliable and may represent a compelling tool for quality assessment in surgery in all parts of the world.
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              Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation.

              Protocols of systematic reviews and meta-analyses allow for planning and documentation of review methods, act as a guard against arbitrary decision making during review conduct, enable readers to assess for the presence of selective reporting against completed reviews, and, when made publicly available, reduce duplication of efforts and potentially prompt collaboration. Evidence documenting the existence of selective reporting and excessive duplication of reviews on the same or similar topics is accumulating and many calls have been made in support of the documentation and public availability of review protocols. Several efforts have emerged in recent years to rectify these problems, including development of an international register for prospective reviews (PROSPERO) and launch of the first open access journal dedicated to the exclusive publication of systematic review products, including protocols (BioMed Central's Systematic Reviews). Furthering these efforts and building on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, an international group of experts has created a guideline to improve the transparency, accuracy, completeness, and frequency of documented systematic review and meta-analysis protocols--PRISMA-P (for protocols) 2015. The PRISMA-P checklist contains 17 items considered to be essential and minimum components of a systematic review or meta-analysis protocol.This PRISMA-P 2015 Explanation and Elaboration paper provides readers with a full understanding of and evidence about the necessity of each item as well as a model example from an existing published protocol. This paper should be read together with the PRISMA-P 2015 statement. Systematic review authors and assessors are strongly encouraged to make use of PRISMA-P when drafting and appraising review protocols. © BMJ Publishing Group Ltd 2014.
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                Author and article information

                Journal
                Transl Androl Urol
                Transl Androl Urol
                TAU
                Translational Andrology and Urology
                AME Publishing Company
                2223-4683
                2223-4691
                May 2021
                May 2021
                : 10
                : 5
                : 2122-2132
                Affiliations
                [1]deptDepartment of Urology, Institute of Urology, West China Hospital , Sichuan University , Chengdu, Sichuan, China
                Author notes

                Contributions: (I) Conception and design: W Wang; (II) Administrative support: X Wei; (III) Provision of study materials or patients: W Wang, L Peng, X Di; (IV) Collection and assembly of data: W Wang, L Peng; (V) Data analysis and interpretation: W Wang, L Peng; (VI) Manuscript writing: All authors/Both authors; (VII) Final approval of manuscript: All authors/Both authors.

                [#]

                These authors contributed equally to this work.

                Correspondence to: Xin Wei. Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China. Email: weixinscu@ 123456scu.edu.cn .
                Article
                tau-10-05-2122
                10.21037/tau-21-39
                8185663
                34159093
                9f12d594-00f0-4124-9bb3-d1f986940f3a
                2021 Translational Andrology and Urology. All rights reserved.

                Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

                History
                : 17 January 2021
                : 14 March 2021
                Categories
                Review Article

                stones,ureteroscopy,shockwave lithotripsy (swl),meta-analysis

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