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Cochrane Database of Systematic Reviews

Intervenciones médicas y alimentarias para la prevención de los cálculos urinarios recurrentes en niños

Information

DOI:
https://doi.org/10.1002/14651858.CD011252.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 09 November 2017see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Urology Group

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Adam Kern

    Anne Arundel Medical Center, Annapolis, USA

  • Gwen Grimsby

    Phoenix Children's Hospital, Phoenix, USA

  • Helen Mayo

    UT Southwestern Library, The University of Texas Southwestern Medical Center, Dallas, USA

  • Linda A Baker

    Correspondence to: Department of Urology, Division of Pediatric Urology, Children's Medical Center/University of Texas Southwestern, Dallas, USA

    [email protected]

    [email protected]

Contributions of authors

Draft the protocol: GG, LB.

Study selection: HM, AK.

Extract data from studies: AK.

Enter data into RevMan: AK.

Carry out the analysis: AK.

Interpret the analysis: AK, LB.

Draft the final review: AK.

Disagreement resolution: LB, GG.

Update the review: AK.

Sources of support

Internal sources

  • Departmental, USA.

External sources

  • No sources of support supplied

Declarations of interest

AK: none known.

GG: none known.

HM: none known.

LB none known.

Acknowledgements

We would like to thank the referees for their comments and feedback during the preparation of this review, and acknowledge Cochrane Urology Group for their support.

Version history

Published

Title

Stage

Authors

Version

2017 Nov 09

Medical and dietary interventions for preventing recurrent urinary stones in children

Review

Adam Kern, Gwen Grimsby, Helen Mayo, Linda A Baker

https://doi.org/10.1002/14651858.CD011252.pub2

2014 Aug 04

Medical and dietary interventions for preventing recurrent urinary stones in children

Protocol

Gwen Grimsby, Helen Mayo, Micah A Jacobs, Linda A Baker

https://doi.org/10.1002/14651858.CD011252

Differences between protocol and review

This review was based on a published protocol (Grimsby 2014), with differences as described here.

In addition to the previously published methodology, the review included plans for GRADE assessment and for preparation of a 'Summary of Findings' tables using GRADEpro GDT software. GRADE assessment is reported in the review, as well as within the 'Summary of findings' table alongside the reportable primary outcome for the main comparison estimable from the available literature.

Due to a combination of low quality available evidence and overall limited numbers of available studies, only one full prospective randomized study was included. There were no high quality descriptive studies available, only low quality descriptive studies by GRADE criteria; therefore, these descriptive studies were not included as planned.

The Newcastle‐Ottawa scoring scale was not utilized for assessment of risk of bias, as the review included no non‐randomized studies (Wells 2012).

Several data collection and analysis steps were not performed since we found no relevant data. For measurement of treatment effect, only dichotomous outcome information was available from the single included study, so no analysis of continuous outcomes data was performed. Similarly, no special analysis was undertaken for unit of analysis issues, as this was not relevant to the single included study, neither was an assessment of heterogeneity of data undertaken. Likewise, data synthesis, subgroup and sensitivity analysis steps were omitted since only one study met inclusion criteria.

We dropped the secondary outcome of number of retreatment per year predefined in the protocol as it was too similar to the primary outcome of retreatment to add value. However, there was no evidence for either outcome.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Risk of bias summary: review authors' judgments about each risk of bias item for each included study (single study).
Figures and Tables -
Figure 1

Risk of bias summary: review authors' judgments about each risk of bias item for each included study (single study).

Study flow diagram.
Figures and Tables -
Figure 2

Study flow diagram.

Risk of bias graph: review authors' judgments about each risk of bias item presented as percentages across all included studies (single study).
Figures and Tables -
Figure 3

Risk of bias graph: review authors' judgments about each risk of bias item presented as percentages across all included studies (single study).

Comparison 1 Potassium citrate versus no treatment, Outcome 1 Stone recurrence and regrowth.
Figures and Tables -
Analysis 1.1

Comparison 1 Potassium citrate versus no treatment, Outcome 1 Stone recurrence and regrowth.

Comparison 1 Potassium citrate versus no treatment, Outcome 2 Adverse events.
Figures and Tables -
Analysis 1.2

Comparison 1 Potassium citrate versus no treatment, Outcome 2 Adverse events.

Summary of findings for the main comparison. Potassium citrate compared to no intervention for preventing urinary stones in children

Patient or population: children with idiopathic urinary calculi treated with shockwave lithotripsy
Setting: likely outpatient
Intervention: potassium citrate
Comparison: no intervention

Outcomes

No of participants
(studies)

Quality of the evidence
(GRADE)

Relative effect
(95% CI)

Anticipated absolute effects* (95% CI)

Risk with no intervention

Risk difference with medical or dietary interventions

Proportion of participants who developed a new urinary stone
follow‐up: mean 24.4 months

96
(1 RCT)

⊕⊕⊝⊝
Low1

RR 0.19
(0.06 to 0.60)

Study population

333 per 1000

270 fewer per 1000
(133 fewer to 313 fewer)

Proportion of participants with adverse events while undergoing intervention

follow‐up: mean 24.4 months

96
(1 RCT)

⊕⊝⊝⊝
Very low1,2,3

RR 13.00
(0.75 to 224.53)

Study population

Proportion of participants undergoing retreatment for urinary stones

no information found

NA

NA

NA

NA

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; RCT: randomized controlled trial; RR: risk ratio; NA: not applicable (since no information found).

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

1Downgraded by two levels for study limitations: almost all domains were unclear or high risk of bias.

2Downgraded by two levels for imprecision: very rare event resulting in very wide confidence interval.

3No event in control arm.

Figures and Tables -
Summary of findings for the main comparison. Potassium citrate compared to no intervention for preventing urinary stones in children
Comparison 1. Potassium citrate versus no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Stone recurrence and regrowth Show forest plot

1

96

Risk Ratio (M‐H, Random, 95% CI)

0.19 [0.06, 0.60]

2 Adverse events Show forest plot

1

96

Risk Ratio (M‐H, Random, 95% CI)

13.00 [0.75, 224.53]

Figures and Tables -
Comparison 1. Potassium citrate versus no treatment