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Panminerva Medica 2016 September;58(3):222-36

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

The evolution of urolithiasis assessment and management in the new millennium

Andreas BOURDOUMIS ^{1, 2}, Athanasios PAPATSORIS ^{2, 3}, John G. CALLEARY ¹, Raveendra SURANGE ¹, Konstantinos SKREPETIS ⁴, Noor BUCHHOLZ ^{2, 5}, Kemal SARICA ^{2, 6} ✉

¹ Department of Urology, Acute Pennine Hospitals NHS Trust, Manchester, UK; ² Section of Urolithiasis, European Association of Urology, Arnhem, The Netherlands; ³ Second Department of Urology, Sismanogleio General Hospital, Athens, Greece; ⁴ Department of Urology, Kalamata General Hospital, Kalamata, Greece; ⁵ Sobeh’s Vascular and Medical Centre, Dubai, United Arab Emirates; ⁶ Department of Urology, Dr. Lutfi KIRDAR Kartal Research and Training Hospital, Istanbul, Turkey

INTRODUCTION: The aim of this review was to identify trends and developments in basic research, epidemiology, diagnosis, conservative and surgical management of urinary stone disease, and to demonstrate the evolution of urolithiasis management in the new millennium.
EVIDENCE ACQUISITION: We performed a literature search on Medline according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement up to December 2015 using the following key words: urolithiasis prevalence, recurrent urinary stone, metabolic syndrome and urolithiasis, urinary stone/urolithiasis metabolic evaluation, shockwave lithotripsy, ureterorenoscopy, percutaneous nephrolithotomy/nephrolitholapaxy. The key words were chosen following consensus as the single most appropriate and descriptive terms that would yield maximal relevant results in a single search for each section. We then segregated only relevant articles in the English language of the highest quality evidence (systematic review/meta-analysis, prospective cohorts and prospective randomized trials, levels of evidence: 1A and 1B, respectively) as well as experimental research. The initial relevance screening was based on title and abstract, whereas further filtering included full text screening. The evidence is subsequently presented and discussed on each relevant section, preceded by seminal references that are used as a basis for comparison to formulate our conclusions.
EVIDENCE SYNTHESIS: By using the key word “urolithiasis prevalence” we identified initially 1581 relevant articles. Following exclusion of duplicates and relevance screening, 154 articles were included for data extraction (9.77%). Of note, 31 articles focused on the pediatric population. By using the key words “metabolic syndrome and urolithiasis” we identified initially 127 relevant articles. Following exclusion of duplicates and relevance screening, 23 articles were included for data extraction (18.11%). It must be noted that the majority of studies are reviews, experimental models and prospective cohorts. By using the key words “urolithiasis metabolic evaluation” we identified initially 262 relevant articles. Following exclusion of duplicates and relevance screening, 179 articles were included for data extraction (68.32%). It must be noted that the majority of studies are reviews, experimental models and prospective cohorts. By using the key word “shockwave lithotripsy” we identified initially 695 relevant articles. Following exclusion of duplicates and relevance screening, 90 articles were included for data extraction (12.94%). By using the key word “ureterorenoscopy” we identified initially 2609 relevant articles. Following exclusion of duplicates and relevance screening, 186 articles were included for data extraction (7.12%). By using the key word “percutaneous nephrolithotomy” we identified initially 695 relevant articles. Following exclusion of duplicates and relevance screening, 381 articles were included for data extraction (10.42%).
CONCLUSIONS: The management of urolithiasis has evolved greatly and in multiple directions in the past fifteen years. There is a definite compartmentalization of basic research, innovation and development focusing on distinct stages of the disease, from epidemiologic features to pathophysiology, medical and surgical aspects. Patients enjoy better delivery of care, having ever more effective options to deal with their condition. The multidisciplinary approach provides more reliable solutions and will continue to drive the development of better preventative and treatment strategies in the future.