PDF(Pubmed)
Abstract：
OBJECTIVE: The infundibulo-pelvic angle (IPA) is reportedly a predictor of successful ureteroscopy for lower pole renal stones, however there is uncertainty at which IPA success is likely. We therefore aimed to perform a meta-analysis and determine at which the angle of likely success and failure.
METHODS: We performed a systematic review and meta-analysis as per Cochrane guidelines in accordance to the PRISMA statement. The review was registered with PROSPERO prior to commencement (ID: CRD42022296732). We included studies reporting on outcomes of ureteroscopy for lower pole stones, with IPA. We excluded patients undergoing alternative treatments for lower pole stones, anatomical abnormalities and studies with < 10 patients. We assessed bias with the Newcastle-Ottawa scale. We performed meta-analysis in R, and summarised the findings as per GRADE.
RESULTS: Overall, there were 13 studies included, with 10 included for meta-analysis. These studies covered n = 1964 patients (71% stone free). Overall, the stone free patients had a significantly less acute mean IPA (52o ± 9o), compared to the non-stone free patients (39o ± 7o), on meta-analysis (REM MD = -13.0, 95% CI: -18.7 to -7.2, p < 0.001). On examination of forest plots, at IPA < 30o no patients were stone free, whilst > 50o all were stone free. Risk of bias was moderate, and certainty of evidence was \'very low\'.
CONCLUSIONS: With a very low certainty of evidence, we demonstrate that at an IPA of < 30o no patient is stone free, whilst > 50o all patients (in this review) are stone free. More evidence is therefore needed.
METHODS: We performed a systematic review and meta-analysis as per Cochrane guidelines in accordance to the PRISMA statement. The review was registered with PROSPERO prior to commencement (ID: CRD42022296732). We included studies reporting on outcomes of ureteroscopy for lower pole stones, with IPA. We excluded patients undergoing alternative treatments for lower pole stones, anatomical abnormalities and studies with < 10 patients. We assessed bias with the Newcastle-Ottawa scale. We performed meta-analysis in R, and summarised the findings as per GRADE.
RESULTS: Overall, there were 13 studies included, with 10 included for meta-analysis. These studies covered n = 1964 patients (71% stone free). Overall, the stone free patients had a significantly less acute mean IPA (52o ± 9o), compared to the non-stone free patients (39o ± 7o), on meta-analysis (REM MD = -13.0, 95% CI: -18.7 to -7.2, p < 0.001). On examination of forest plots, at IPA < 30o no patients were stone free, whilst > 50o all were stone free. Risk of bias was moderate, and certainty of evidence was \'very low\'.
CONCLUSIONS: With a very low certainty of evidence, we demonstrate that at an IPA of < 30o no patient is stone free, whilst > 50o all patients (in this review) are stone free. More evidence is therefore needed.
摘要：
目的：据报道，盆底漏斗角（IPA）是输尿管镜检查下极肾结石成功的预测指标，然而，IPA成功的可能性存在不确定性。因此，我们旨在进行荟萃分析，并确定可能的成功和失败的角度。
方法：我们根据PRISMA声明，按照Cochrane指南进行了系统评价和荟萃分析。审查在开始之前在PROSPERO注册(ID:CRD42022296732)。我们纳入了关于输尿管镜检查下极结石结果的研究，与IPA。我们排除了接受下极结石替代疗法的患者，解剖异常和<10例患者的研究。我们用纽卡斯尔-渥太华量表评估了偏见。我们在R，并按等级总结了调查结果。
结果：总体而言，包括13项研究，纳入10个进行荟萃分析。这些研究涵盖了n=1964名患者（71％无结石）。总的来说,无结石患者的急性平均IPA明显较低（52o±9o），与非结石患者相比（39o±7o），荟萃分析（REMMD=-13.0，95%CI：-18.7至-7.2，p<0.001）。在检查森林地块时，在IPA<30o时，没有患者没有结石，而>50o都是免费的。偏见的风险是中等的，证据的确定性“非常低”。
结论：证据的确定性非常低，我们证明，在<30的IPA下，没有病人是无结石的，而>50o所有患者(在这篇综述中)都没有结石。因此需要更多的证据。
方法：我们根据PRISMA声明，按照Cochrane指南进行了系统评价和荟萃分析。审查在开始之前在PROSPERO注册(ID:CRD42022296732)。我们纳入了关于输尿管镜检查下极结石结果的研究，与IPA。我们排除了接受下极结石替代疗法的患者，解剖异常和<10例患者的研究。我们用纽卡斯尔-渥太华量表评估了偏见。我们在R，并按等级总结了调查结果。
结果：总体而言，包括13项研究，纳入10个进行荟萃分析。这些研究涵盖了n=1964名患者（71％无结石）。总的来说,无结石患者的急性平均IPA明显较低（52o±9o），与非结石患者相比（39o±7o），荟萃分析（REMMD=-13.0，95%CI：-18.7至-7.2，p<0.001）。在检查森林地块时，在IPA<30o时，没有患者没有结石，而>50o都是免费的。偏见的风险是中等的，证据的确定性“非常低”。
结论：证据的确定性非常低，我们证明，在<30的IPA下，没有病人是无结石的，而>50o所有患者(在这篇综述中)都没有结石。因此需要更多的证据。
