Comparison of retrograde flexible ureteroscopy and percutaneous nephrolithotomy in treating intermediate-size renal stones (2-3cm): a meta-analysis and systematic review

Abstract

Purpose: To systematically assess the effectiveness and safety of retrograde flexible ureteroscopy (FURS) versus percutaneous nephrolithotomy (PCNL) in treating intermediate-size renal stones (2-3cm). Materials and Methods: PubMed, Ovid MEDLINE, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE were researched to identify relevant studies up to May 2018. Article selection was performed through the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. The Newcastle-Ottawa Scale was applied to assess the methodological quality of case-control studies. Results: Six retrospective case-controlled trials were included for meta-analysis. The pooled results showed that PCNL was associated with a higher initial stone-free rate (SFR). After more complementary treatments, FURS provided a final SFR (OR: 1.69; 95% CI, 0.93-3.05; P = 0.08) comparable to that achieved by PCNL. PCNL was associated with a higher rate of overall intraoperative complications (OR: 1.48; 95% CI, 1.01-2.17; P = 0.04) and longer hospital stay (MD: 2.21 days; 95% CI, 1.11 to 3.30; P < 0.001). Subgroup analysis by Clavien-graded complication showed PCNL had significantly higher rates of minor complications (OR: 1.58; 95% CI, 1.04-2.41; P = 0.03). No significant difference was noted in major complications (OR: 1.14; 95% CI, 0.53-2.45; P = 0.73) or operative times (MD: −9.71 min; 95% CI, −22.02 to 2.60; P = 0.12). Conclusions: Multisession FURS is an effective and safe alternative to PCNL for the management of intermediate-size renal stones (2-3cm). It is advisable to balance the benefits and risks according to the individual characteristics of patients and to decide with patients by discussing the advantages and disadvantages of each procedure.

Forecast and Guiding role of using Hounsfield unit in retrograde intrarenal surgery for the treatment of renal stone of 2-3 cm: A single center prospective study

“…Our results con rmed that PCNL offered a higher SFR than RIRS as well, which was consistent with most published studies [8,20,2]. Zewu et al supposed that the potential reasons for RIRS with a relatively lower SFR may be due to residual fragments that are more likely to represent a cluster of clinically insigni cant fragments and small working channel according literatures [25], as well as a call for the vacuum aspiration stone system for RIRS. However, RIRS with HU value evaluated could provide a comparable nal SFR and shorter recovery time with fewer overall complications for intermediate-size renal stones (2-3 cm) in one session with help of adjuvant ESWL in many cases.…”

External validation of the T.O.HO. score and derivation of the modified T.O.HO. score for predicting stone-free status after flexible ureteroscopy in ureteral and renal stones

“…2,21 In a recent meta-analysis, the final SFR was reported to be 89.4% in an average of 1.4 procedures performed in 2-3 cm stones, and this rate was stated to be comparable to PCNL. 22 Although complication rates of up to 16% have been reported in previous studies, most were classified as minor. In addition to the development in fURS technology, increasing surgical experience has reduced the rate of major complication from 5.01% between 1990 and 2011 to 1.48% between 2011 and 2016 and increased the success of treatment.…”

The effects of pregabalin, solifenacin and their combination therapy on ureteral double-J stent-related symptoms: A randomized controlled clinical trial

“…Percutaneous nephrolithotomy (PCNL) is recommended as the first-line treatment of choice for renal stones more than 2cm in diameter and retrograde flexible ureteroscopy (FURS) is an effective and safe alternative to PCNL and in treating intermediate--size renal stones (2-3cm). Following these procedures sometimes it is mandatory to insert DJ (16,17). DJ stent is known as useful and routine instrumentation in urology surgeries that reduces obstruction of the upper urinary tract, deflects the urine outflow, helps ureter dilatation for stone passing and helps to heal the tissue by reduction of inflammation.…”