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Micropercutaneous nephrolithotomy versus retrograde intrarenal surgery in the treatment of renal stones: A systematic review and meta-analysis.

ABSTRACT: OBJECTIVE:To compare the efficacy and safety of micropercutaneous nephrolithotomy (Microperc) and retrograde intrarenal surgery (RIRS) in treating renal stones using published literature. METHODS:A systematic literature review was performed on August 21, 2017, using PubMed, Embase, and Cochrane Library databases in accordance with the PRISMA guidelines. Summarized mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the differences in outcomes between Microperc and RIRS. RESULTS:A total of nine studies (7 in adult patients and 2 in pediatric patients) containing 842 patients (381 Microperc cases and 461 RIRS cases) with renal stones were included in this analysis. Among the adult patients, Microperc was associated with higher stone-free rate(SFR)(OR: 1.6; 95% CI, 1.03 to 2.48), significantly longer hospital stays (MD: 0.66 day; 95% CI, 0.17 to 1.15), longer fluoroscopy time (MD: 78.12 s; 95% CI, 66.08 to 90.15), and larger decreases in hemoglobin (MD: 0.59 g/dl; 95% CI, 0.16 to 1.02) than was RIRS. No significant differences were observed with respect to operative time, stone-free rate, complication rate or auxiliary procedures. CONCLUSIONS:Our results demonstrated that Microperc might be more effective in adult patients than RIRS will due to its higher SFR. However, longer hospital stays, longer fluoroscopy time and a larger decrease in hemoglobin should be considered cautiously.

SUBMITTER: Li X

PROVIDER: S-EPMC6195289 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Micropercutaneous nephrolithotomy versus retrograde intrarenal surgery in the treatment of renal stones: A systematic review and meta-analysis.

Li Xiaohang X Li Jiuzhi J Zhu Wei W Duan Xiaolu X Zhao Zhijian Z Deng Tuo T Duan Haifeng H Zeng Guohua G

PloS one 20181019 10

<h4>Objective</h4>To compare the efficacy and safety of micropercutaneous nephrolithotomy (Microperc) and retrograde intrarenal surgery (RIRS) in treating renal stones using published literature.<h4>Methods</h4>A systematic literature review was performed on August 21, 2017, using PubMed, Embase, and Cochrane Library databases in accordance with the PRISMA guidelines. Summarized mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the differences in ...[more]

PMID: 30339676

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Project description:BackgroundShock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and minimally invasive PCNL are currently therapeutic options for lower-pole renal stones (LPS). However, the optimal treatment for LPS remains unclear. A comprehensive evaluation of the efficacy and safety of each intervention is needed to inform clinical decision-making. This study aimed at assessing the efficacy and safety of different interventions for LPS.MethodsPubMed, Embase, ScienceDirect, ClinicalKey, Cochrane Library, ProQuest, Web of Science, and ClinicalTrials.gov were searched from inception to December 6th 2018. Only randomized controlled trials (RCTs) including the patients treated for LPS were included. The frequentist models of network meta-analysis were used to compare the effect sizes. The primary outcome was stone free rate, and the secondary outcomes were overall complication rate, major complication rate, retreatment rate, and auxiliary procedure rate.ResultsThis study included 13 RCTs comprising 1832 participants undergoing 6 different interventions, including RIRS, PCNL, Mini-PCNL, Micro-PCNL, SWL, and conservative observation. PCNL had the best stone free rate (odds ratio [OR] = 3.45, 95% confidence interval [CI] = 1.30-9.12), followed by Mini-PCNL (OR = 2.90, 95% CI = 1.13-7.46). Meta-regression did not find any association of the treatment effect with age, sex, and stone size. Although PCNL tended to exhibit a higher complication rate, the difference of complication rate among various interventions did not achieve a statistical significance. SWL was the less effective and associated with higher retreatment rate compared with PCNL, Mini-PNCL, and RIRS.ConclusionsPCNL was associated with the best stone free rate for LPS regardless of age, sex, and stone size. Each treatment achieved a similar complication rate compared with the others. Future large-scale RCTs are warranted to identify the most beneficial management for renal stones at a more complicated location.

Project description:Objectives Kidney stone in children is a recurring problem that requires multiple interventions over time. Minimally-invasive approach, such as Extracorporeal Shockwave Lithotripsy (ESWL) is recommended for moderately-sized stones. However, since ESWL is associated with multiple interventions, Micro-Percutaneous Nephrolithotomy (Micro-PCNL) and Retrograde Intrarenal Surgery (RIRS) can also be considered to treat kidney stones in pediatric patients. Both approaches have their respective advantages and disadvantages. In this study, we aimed to compare the efficacy and safety of Micro-PCNL and RIRS in pediatric patients with kidney stones. Methods This systematic review and meta-analysis adhered to the PRISMA guideline and Cochrane Handbook of intervention. The included studies were obtained from the PubMed and ScienceDirect databases. The protocol of this review has been registered in PROSPERO (CRD42021265894). The quality of the studies was assessed using the Newcastle-Ottawa Scale, outcomes were analyzed using STATA®16, and certainty of evidence was evaluated using GRADE. Results A total of 239 participants were included in this study, divided into the Micro-PCNL (n = 112) and RIRS (n = 127) procedure groups. Statistical analysis revealed a significantly lower requirement of postoperative stenting procedure in Micro-PCNL compared to RIRS (OR 0.09; 95%CI 0.02, 0.47; p < 0.01). However, no significant difference was found in stone-free rate (p = 0.86), operative time (p = 0.09), UTI incidence (p = 0.67), blood transfusion requirement (p = 0.95), and length of stay (p = 0.77). Conclusion Micro-PCNL is superior to RIRS in managing pediatric kidney stones,10–20 mm in size based on their comparable SFR and fewer requirements of additional stenting procedures. Highlights • Micro-PCNL had a comparable SFR to RIRS in managing pediatric kidney stones,10–20 mm.• Micro-PCNL had less requirement of stenting procedure than RIRS in managing pediatric kidney stones,10–20 mm.• Micro-PCNL is superior to RIRS in managing pediatric kidney stones,10–20 mm.

Dataset Information

Micropercutaneous nephrolithotomy versus retrograde intrarenal surgery in the treatment of renal stones: A systematic review and meta-analysis.

Publications

Micropercutaneous nephrolithotomy versus retrograde intrarenal surgery in the treatment of renal stones: A systematic review and meta-analysis.

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