Kidney stones: flexible ureteroscopy.

Introduction: The age of peak incidence for stone disease is 20 to 40 years, although stones are seen in all age groups. There is a male to female ratio of 3:2.

Methods And Outcomes: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of flexible ureteroscopy for the removal of renal stones? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).

Results: At this update, searching of electronic databases retrieved 197 studies. After deduplication and removal of conference abstracts, 118 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 99 studies and the further review of 18 full publications. Of the 18 full articles evaluated, one systematic review and four RCTs were added at this update. We performed a GRADE evaluation for eight PICO combinations.

Conclusions: In this systematic overview, we categorised the efficacy for four interventions, based on information relating to the effectiveness and safety of: flexible ureteroscopy (combined with snare or basket or laser lithotripsy) versus expectant management, flexible ureteroscopy (combined with snare or basket or laser lithotripsy) versus extracorporeal shockwave lithotripsy, flexible ureteroscopy (combined with snare or basket or laser lithotripsy) versus percutaneous nephrolithotomy.