Holmium: YAG laser lithotripsy versus pneumatic lithotripsy for treatment of distal ureteral calculi: a meta-analysis.

The objective of this study was to estimate the treatment effect of Pneumatic Lithotripsy (PL) versus holmium: YAG laser lithotripsy (LL) in the treatment of distal ureteric calculi. A bibliographic search covering the period from 1990 to April 2012 was conducted using search engines such as MEDLINE, EMBASE, and Cochrane library. Data were extracted and analyzed with RevMan5.1 software. A total of 47 studies were scant, and 4 independent studies were finally recruited. Holmium: YAG LL conveyed significant benefits compared with PL in terms of early stone-free rate [odds ratio (OR) = 4.42, 95% confidence interval (CI) (1.14, 17.16), p = 0.03], delayed stone-free rate [OR = 4.42, 95% CI (1.58, 12.37), p = 0.005], mean operative time [WMD = -16.86, 95% CI (-21.33, -12.39), p < 0.00001], retaining double-J catheter rate [OR = 0.44, 95% CI (0.25, 0.78), p = 0.004], and stone migration incidence [OR = 0.26, 95% CI (0.11, 0.62), p = 0.003], but not yet in the postoperative hematuria rate and the ureteral perforation rate according to this meta-analysis. Precise estimates on larger sample size and trials of high quality may provide more uncovered outcomes in the future.