Efficacy and safety of minimally invasive percutaneous nephrolithotomy versus retrograde intrarenal surgery in the treatment of upper urinary tract stones (> 1 cm): a systematic review and meta-analysis of 18 randomized controlled trials

BMC Urology

Research

Yu Jiang¹  Erhao Bao²  Yang Liu²  Zhi Wen²  Jing Huang²  Xuesong Yang²  Chongjian Wang²  Caixia Chen²  Jiahao Wang²  Huimin Zhang³ 

[1] Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China;Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China;Department of Urology, Chengdu Xinhua Hospital Affiliated to North Sichuan Medical College, ChengDu, China;

关键词: mPCNL;    RIRS;    Urinary tract stones;    Stone free rate;    Urolithiasis;    Complications;   

DOI  :  10.1186/s12894-023-01341-3

 received in 2023-06-15, accepted in 2023-10-14,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe advantages and disadvantages of retrograde intrarenal surgery (RIRS) and minimally invasive percutaneous nephrolithotomy (mPCNL) for treatment of upper urinary tract calculi have not been conclusively determined.MethodsIn this meta-analysis, We comprehensively evaluated the performance of the two surgical approaches in treatment of upper urinary calculi. We searched the Pubmed, Embase, Cochrane and Web of science databases for randomized controlled trial (RCT) articles on RIRS and mPCNL upto December 2022. Data were extracted by two independent reviewers and subjected to the meta-analysis using the Stata 15.1 software (StataSE, USA).ResultsA total of 18 eligible RCTs involving 1733 patients were included in this study. The meta-analysis revealed that mPCNL of 1–2 cm or 2–3 cm stones had a higher stone clearance rate (RR:1.08, 95%CI (1.03, 1.14), p = 0.002) and shorter operation time (WMD : -10.85 min, 95%CI (-16.76, -4.94), p<0.001). However, it was associated with more hospital stay time (WMD :1.01 day, 95%CI(0.53, 1.5), p<0.001), hemoglobin drops (WMD :0.27 g/dl, 95%CI (0.14, 0.41), p<0.001), blood transfusion rate (RR:5.04, 95%CI(1.62, 15.65), p = 0.005), pain visual analogue score (WMD:0.75, 95%CI (0.04, 1.46), p = 0.037), hospital costs (SMD :-0.97, 95%CI (-1.19, -0.76), p<0.001) and major complications (RR:1.89, 95%CI(1.01, 3.53), p = 0.045).ConclusionTherefore, in terms of surgical effects and operation time, mPCNL is superior to RIRS, but is inferior with regards to other perioperative parameters. These factors should be fully considered in clinical decision making.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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