Efficacy and Safety of Semirigid Ureteroscopy Combined with Holmium:yttrium-aluminum-garnet Laser Lithotripsy for the Treatment of Proximal Ureteral Calculi: A Single-arm Meta-analysis.

Background And Objective: Ureteral stones are currently treated with holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripsy using rigid and flexible ureteroscopes. This study aims to evaluate the efficacy and safety of semirigid ureteroscopy combined with Ho:YAG laser lithotripsy for treating proximal ureteral stones in real-world studies.

Methods: The PubMed, Embase, and Web of Science databases were searched systematically to retrieve all relevant studies up to April 2024. A meta-analysis of the retrieved studies was performed using Stata 14.0 software and expressed as rate, mean difference, and 95% confidence interval (CI). The main outcomes of this meta-analysis were stone-free rate (SFR) and perioperative outcomes including operation time, hospital stay, postoperative ureteral stent placement, auxiliary procedures, and intra- or postoperative complications.

Key Findings And Limitations: A total of 24 studies were included in this study, including 2058 patients with proximal ureteral stones. According to the results of the combined analysis, the SFR of semirigid ureteroscopy combined with Ho:YAG laser lithotripsy for the treatment of proximal ureteral stones was 78% (95% CI [75%, 82%]), operation time was 51.03 min (95% CI [43.5, 58.56]), hospital stay was 1.62 d (95% CI [1.54, 1.70]), auxiliary procedure rate was 20% (95% CI [15%, 25%]), and postoperative complication rate was 16% (95% CI [12%, 22%]).

Conclusions And Clinical Implications: The results of this study show that semirigid ureteroscopic Ho:YAG laser lithotripsy is a commonly used treatment for proximal ureteral calculi, but its efficacy and safety need to be improved further, and its efficacy is not related to the diameter of the endoscope.

Patient Summary: This study showed that Ho:YAG laser lithotripsy with semirigid ureteroscopes is commonly used for treating ureteral stones. However, its efficacy and safety need to be improved further, and future research should focus on these.