Comparison of mini percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for renal stones >2cm: a systematic review and meta-analysis

Abstract

Background: The purpose is to compare the efficacy and safety of mini percutaneous nephrolithotomy (mini-PCNL) versus standard percutaneous nephrolithotomy (standard-PCNL) in patients with renal stones >2cm. Materials and Methods: A systematic literature search was conducted in PubMed, Web of Science, Scopus, and the Cochrane Library databases to identify relevant studies before March 8, 2021. Stone-free rate (SFR), operation time, fever rate, hemoglobin drop, blood transfusion rate, and hospitalization time were used as outcomes to compare mini-PCNL and standard-PCNL. The meta-analysis was performed using the Review Manager version 5.4. Results: Seven randomized controlled trials were included in our meta-analysis, involving 1407 mini-PCNL cases and 1436 standard-PCNL cases. Our results reveal that, for renal stones >2cm, mini-PCNL has a similar SFR (risk ratio (RR)=1.01, 95% confidence interval (CI): 0.98 to 1.04, p=0.57) and fever rate (RR=1.22, 95% CI: 0.97-1.51, p=0.08). Standard-PCNL was associated with a significantly shorter operating time (weighted mean difference (WMD)=8.23, 95% CI: 3.44 to 13.01, p <0.01) and a longer hospitalization time (WMD=-20.05, 95% CI: -29.28 to -10.81, p <0.01) than mini-PCNL. Subgroup analysis showed hemoglobin drop and blood transfusion for 30F standard-PCNL were more common than mini-PCNL (WMD=-0.95, 95% CI: -1.40 to -0.50, p <0.01; RR=0.20, 95% CI: 0.07 to 0.58, p <0.01). Conclusion:In the treatment of >2cm renal stones, mini-PCNL should be considered an effective and reliable alternative to standard-PCNL (30F). It achieves a comparable SFR to standard-PCNL, but with less blood loss, lower transfusion rate, and shorter hospitalization. However, the mini-PCNL does not show a significant advantage over the 24F standard-PCNL. On the contrary, this procedure takes a longer operation time.Trial registration: This meta-analysis was reported consistent with the PRISMA statement and was registered on PROSPERO, with registration number 2021CRD42021234893.

Will the advances in retrograde intrarenal surgery extinguish percutaneous nephrolithotomy for stones larger than 2 cm?

“…But perhaps, the most notorious evolution in standard PCNL was the significant shift to miniaturized PCNL (mini-PCNL) allowing reduced parenchymal renal injury. This technique offers a midway option between conventional PCNL and less invasive endoscopic procedures such as RIRS and implicates in using a tract smaller than 22F ( 46 ). The reusable equipment and the vacuum cleaner “vortex” effect make mini PCNL more affordable than standard PCNL.…”

A novel nomogram and a simple scoring system for urinary leakage after percutaneous nephrolithotomy

“…The optimal cut--off value of the scoring system was 6.5, at which it had 76.1% sensitivity and specificity of 71.0% in predicting PUL. Based on novel scores, the patients were divided into the risk groups of low (3)(4)(5)(6), moderate (7)(8)(9), and high (10-11) (Figure -3), which were found to have the PUL rates of 3.6%, 19.4%, and 80%, respectively.…”

“…Despite the high efficacy of PCNL, complications of up to 20-83% are described in the literature. The most common of these complications are postoperative fever (4-32.1%), bleeding requiring transfusion (10.9-17.5%), and urine extravasation (7.2%) (3)(4)(5). However, when complications are classified according to the Clavien scoring system, the most common grade-3 complication is urine leakage persisting for >24 h (4%) treated by a double-J (DJ) ureteral stent (3).…”

Deep learning model-assisted detection of kidney stones on computed tomography

“…The cost of nephrolithiasis management is high for both individuals and the society. The choice of the most appropriate treatment for kidney stones is challenging because it depends on several factors such as the type, shape, size, and location of the stones (4).…”