Background: We conducted a systematic review and meta-analysis to determine the efficacy and safety of mini-Percutaneous Nephrolithotomy (PCNL) compared to standard PCNL in children with nephrolithiasis. Clinical trials and observational studies comparing standard PCNL and mini-PCNL in pediatric patients were identified from electronic databases in November 2021. Method: Studies were extracted for author, year, location, design, subjects’ age, sample size, objective, primary endpoint, level of evidence, and results (stone-free rates and complications). Results were subjected to qualitative analysis using the synthesis method. Adequate results were extracted and analyzed quantitatively using the fixed-effect model on homogenous data or the random-effect model on heterogeneous data for meta-analysis. Outcome variables are shown as odds ratios (ORs) with 95% confidence intervals (CIs). All statistical analyses were performed with Review Manager version 5.4. Result: We reported that stone-free rate and residual stone vary between two studies with contrary results. However, our quantitative analysis showed an insignificant difference between both groups of stone-free rate (OR 0.75; 95% CI 0.22-2.54) and residual stone (OR 1.27; 95% CI 0.55-2.91). Complications rates were insignificantly different between mini-PCNL group and PCNL group in two studies in Clavien 1 (OR 0.65; 95% CI 0.27-1.54) and Clavien 2 grade (OR 0.48; 95% CI 0.19-1.22). In addition, pooled analysis of both complication grades was also insignificant in the difference between groups (OR 0.56; 95% CI 0.30-1.06). Conclusion: The efficacy and safety of mini PCNL were neither superior nor inferior compared to standard PCNL in managing nephrolithiasis in pediatric patients. Moreover, mini PCNL was considered better regarding post-operative pain and tract infection; thus, mini PCNL could be considered a treatment option for pediatric patients with nephrolithiasis.
BACKGROUND: Buccal mucosal graft (BMG) has been a widely known technique for anterior urethral reconstruction; however, the studies regarding its morbidity are still limited. AIM: The purpose of this study is to compare postoperative morbidity outcome between closure versus non-closure BMG harvest site in patients with urethral stricture underwent urethroplasty. METHODS: A systematic review and meta-analysis of randomized controlled trials and prospective cohort studies was conducted. Literature searching was done through electronic databases, including PubMed, Science Direct, EBSCO, ProQuest, and Google Scholar. The inclusion criteria were men diagnosed with urethral stricture and underwent urethroplasty procedure. The participants were two groups of patients divided based on whether their BMG harvest site was closed or left open. No exclusion criteria applied to the types of participants. The statistical analysis was performed using Review Manager version 5.3 software. Cochrane risk-of-bias tool was used to evaluate the quality of the study. RESULTS: We analyzed five studies qualitatively and three studies quantitatively. There was no significant difference between the closure and non-closure BMG in pooled standard mean difference (SMD) on the oral pain in day-1 and month-6 post-operation. However, pain score in day-1 post-operation was slightly higher in the closure group (SMD 0.49, 95% CI –0.31, 1.30). The incidence of perioral numbness in day-1 post-operation was significantly higher in the closure group (RR 1.48, 95% CI 1.04, 2.10, p < 0.05). The incidence of difficulty in opening mouth in day-1 post-operation also significantly higher in closure group (RR 1.48, 95% CI 1.14, 1.91, p = 0.003). There was no significant morbidity difference between two groups reported in five studies included after 6 months post-operation. CONCLUSION: There was no significant difference between closure and non-closure of BMG in the post-operative pain morbidity. However, the incidence of the early perioral numbness and difficulty in mouth opening was significantly lower in non-closure group.
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