Evaluation of outcomes in kidney stone management: Stone-free rate vs Cost vs Quality of life – A systematic review from EAU Endourology

Evaluation of outcomes in kidney stone management: Stone-free rate vs Cost vs Quality of life – A systematic review from EAU Endourology | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Evaluation of outcomes in kidney stone management: Stone-free rate vs Cost vs Quality of life – A systematic review from EAU Endourology Khodr Terro, Joren Vanthoor, Oliver Wiseman This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8071973/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Nephrolithiasis is a prevalent and highly recurrent pathology that affects up to 15% of the global population. The three main treatment modalities of nephrolithiasis are extracorporeal shock wave lithotripsy (ESWL) , ureteroscopy (URS) , and percutaneous nephrolithotomy (PCNL) , however they differ in efficacy, invasiveness, and cost. Although stone-free rate (SFR) remains the traditional measure of success, a comprehensive evaluation should integrate economic and patient-centered outcomes. Objective: To compare stone-free rate (SFR), cost, and quality-of-life (QoL) outcomes for patients undergoing ESWL, URS, and PCNL. Methods: A systematic review was conducted following the PICO framework. We identified comparative studies involving adult patients (≥ 18 years) with renal stones using PubMed, Embase, Scopus, and Cochrane Library. The primary outcomes included SFR, treatment cost, clinical outcomes and QoL scores. Quantitative and qualitative meta-analyses were performed in R software. Results: Forty six studies were included in this systematic review. PCNL achieved the highest SFR , followed by URS , and ESWL demonstrated the lowest (RR = 1.13 for PCNL vs URS, p < 0.0001). Moreover, ESWL was the cheapest, while PCNL was the most expensive. Hospital stay and transfusion rates increased proportionally with procedural invasiveness. URS had the lowest complication and retreatment rates , while ESWL and PCNL had the highest retreatment rates and complication rates respectively. No statistically significant differences were found in QoL outcomes among the treatment modalities. Conclusions: PCNL remains the most effective but most invasive treatment, URS offers a balanced compromise of efficacy, safety, and cost, while ESWL is the least invasive and most economical option but carries the highest risk of retreatment. Future studies should standardize reporting of SFR, cost-effectiveness, quality-of-life measures, and procedural variations. Urology & Nephrology Kidney stone disease Nephrolithiasis Extracorporeal shock wave lithotripsy (ESWL) Ureteroscopy (URS) Percutaneous nephrolithotomy (PCNL) Stone-free rate Cost-effectiveness Quality of life Meta-analysis Systematic review Full Text Additional Declarations The authors declare potential competing interests as follows: Oliver Wiseman: Consultant/ Education: BSc, EMS, Ambu, Pusen, Penlan Healthcare Research: EMS, Director: UroScreen Ltd Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8071973","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":542342480,"identity":"f28a6e27-3859-47c3-b6ac-8085072c0613","order_by":0,"name":"Khodr 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Ltd\n","formattedTitle":"\u003cp\u003e\u003cstrong\u003eEvaluation of outcomes in kidney stone management: Stone-free rate vs Cost vs Quality of life – A systematic review from EAU Endourology\u003c/strong\u003e\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Cambridge University Hospitals NHS Foundation Trust","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Kidney stone disease, Nephrolithiasis, Extracorporeal shock wave lithotripsy (ESWL), Ureteroscopy (URS), Percutaneous nephrolithotomy (PCNL), Stone-free rate, Cost-effectiveness, Quality of life, Meta-analysis, Systematic review","lastPublishedDoi":"10.21203/rs.3.rs-8071973/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8071973/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e\u003cp\u003eNephrolithiasis is a prevalent and highly recurrent pathology that affects up to 15% of the global population. The three main treatment modalities of nephrolithiasis are \u003cb\u003eextracorporeal shock wave lithotripsy (ESWL)\u003c/b\u003e, \u003cb\u003eureteroscopy (URS)\u003c/b\u003e, and \u003cb\u003epercutaneous nephrolithotomy (PCNL)\u003c/b\u003e, however they differ in efficacy, invasiveness, and cost. Although stone-free rate (SFR) remains the traditional measure of success, a comprehensive evaluation should integrate economic and patient-centered outcomes.\u003c/p\u003e\u003ch2\u003eObjective:\u003c/h2\u003e\u003cp\u003eTo compare \u003cb\u003estone-free rate (SFR), cost, and quality-of-life (QoL)\u003c/b\u003e outcomes for patients undergoing ESWL, URS, and PCNL.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003eA systematic review was conducted following the PICO framework. We identified comparative studies involving adult patients (\u0026ge;\u0026thinsp;18 years) with renal stones using PubMed, Embase, Scopus, and Cochrane Library. The primary outcomes included SFR, treatment cost, clinical outcomes and QoL scores. Quantitative and qualitative meta-analyses were performed in R software.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eForty six studies were included in this systematic review. \u003cb\u003ePCNL\u003c/b\u003e achieved the highest \u003cb\u003eSFR\u003c/b\u003e, followed by \u003cb\u003eURS\u003c/b\u003e, and \u003cb\u003eESWL\u003c/b\u003e demonstrated the lowest (RR\u0026thinsp;=\u0026thinsp;1.13 for PCNL vs URS, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Moreover, \u003cb\u003eESWL\u003c/b\u003e was the cheapest, while \u003cb\u003ePCNL\u003c/b\u003e was the most expensive. \u003cb\u003eHospital stay\u003c/b\u003e and \u003cb\u003etransfusion rates\u003c/b\u003e increased proportionally with procedural invasiveness. \u003cb\u003eURS\u003c/b\u003e had the lowest \u003cb\u003ecomplication\u003c/b\u003e and \u003cb\u003eretreatment rates\u003c/b\u003e, while \u003cb\u003eESWL\u003c/b\u003e and \u003cb\u003ePCNL\u003c/b\u003e had the highest \u003cb\u003eretreatment rates\u003c/b\u003e and \u003cb\u003ecomplication rates\u003c/b\u003e respectively. No statistically significant differences were found in \u003cb\u003eQoL\u003c/b\u003e outcomes among the treatment modalities.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e\u003cp\u003e\u003cb\u003ePCNL\u003c/b\u003e remains the most effective but most invasive treatment, \u003cb\u003eURS\u003c/b\u003e offers a balanced compromise of efficacy, safety, and cost, while \u003cb\u003eESWL\u003c/b\u003e is the least invasive and most economical option but carries the highest risk of retreatment. Future studies should standardize reporting of SFR, cost-effectiveness, quality-of-life measures, and procedural variations.\u003c/p\u003e","manuscriptTitle":"Evaluation of outcomes in kidney stone management: Stone-free rate vs Cost vs Quality of life – A systematic review from EAU Endourology","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-11 12:38:00","doi":"10.21203/rs.3.rs-8071973/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a1d9a7ed-0eb3-40a2-ba5a-5c235f19c555","owner":[],"postedDate":"November 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":57801758,"name":"Urology \u0026 Nephrology"}],"tags":[],"updatedAt":"2025-11-11T12:38:00+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-11 12:38:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8071973","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8071973","identity":"rs-8071973","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}