A Meta-Analysis and Systematic Review of Holmium Laser Treatment of Bladder Stones

Jie Lv; Ning Wang; Yongsheng Zhu; Qian Luo; Yongxian Li; Jian Li


Transl Androl Urol. 2021;10(8):3465-3475. 

In This Article


Literature Inclusion and Exclusion Criteria

Inclusion criteria: (I) the research subjects were patients who had been clinically diagnosed with vesical calculi; (II) the articles were RCTs in the English language; and (III) patients in the experimental group underwent holmium laser lithotripsy, and those in the control group underwent pneumatic lithotripsy (the baseline data of the 2 groups had to be comparable; (IV) the patients could be treated by conservative treatment; and (V) the evaluation indicators included patients' satisfaction after surgery and the occurrence of adverse reactions.

Exclusion criteria: (I) a RCT had not been conducted; rather, the article was about a retrospective study, case report, or cohort study; (II) the research subjects were animals; (III) the article was unpublished, such as a degree thesis, or was in a language other than English; (IV) patients in the experimental group had undergone a cystectomy, or another conservative treatment; (V) the patients had other diseases; and/or (VI) the research data was incomplete.

Literature Retrieve

The PubMed, Embase, Medline, Ovid, Springer, and Web of Sciences databases were searched since their establishment to December 31, 2020, with "Holmium laser lithotripsy," "Pneumatic lithotripsy," "Urology Surgery," and "Vesical Calculi," used as search terms.

Literature Screening

After the articles were retrieved, NoreExpress 3.2 was used to identify duplicates, which were then removed. Next, the 2 researchers read the titles and abstracts to eliminate articles that obviously did not meet the inclusion criteria.

Data Extraction

The following data were collated: (I) the title and the name of the first author (only 1), the publication time, and the research content; (II) the age of the patients, the sample size, and baseline comparability; (III) the research plan, intervention methods, and the anti-bias measures; and (IV) the outcome indexes and data.

Bias Risk Assessment

The bias risk was evaluated concerning the generation of the random sequence, the blind method applied to patients and the experimental personnel, the blind method applied to outcomes evaluation, whether the data was complete, whether there was a selective report, and whether there were other bias sources.

Statistical Analysis

The risk of bias was assessed using the Cochrane Handbook for Systematic Reviews of Interventions 5.0.2. STATA11.0 software was used to count the included literature. RevMan5.3 was used to perform the meta-analysis. Relative risk (RR) was used as the effect size for the binary variables in the count data, and the 95% confidence interval (CI) was calculated. The I2 test was used to evaluate the heterogeneity of the included literature. If I2 was >50%, a random-effects model (REM) was used; if I2 was <50%, a fixed-effects model (FEM) was used. The combined effect size test adopted a U-test and 95% CI. The U-test result was expressed as a P value; a P<0.05 was the threshold for significance.