Comparative effectiveness and safety of various treatment procedures for lower pole renal calculi: a systematic review and network meta‐analysis

Abstract

Objective To compare the effectiveness of various treatments used for lower pole renal calculi. Methods We searched PubMed, EMBASE, CINAHL, the Cochrane Collaboration's Database of Systematic Reviews, the Cochrane Collaboration Central Register of Controlled Clinical Trials as well as ClinicalTrials.gov for reports up to 1 April 2014. The search was supplemented with abstract reports from various urology conferences. All randomised, ‘blinded’ clinical studies including patients treated for lower pole renal calculi of <20 mm were included for review. Two authors independently reviewed 5 194 articles, and identified and selected 13 trials for analysis. Network meta‐analysis was performed to generate comparative statistics, while quality was assessed with the Jadad composite scale and risk of bias. Results All treatment methods examined: percutaneous nephrolithotomy (PNL), ureterorenoscopy (URS) and extracorporeal shockwave lithotripsy (SWL) with an adjuvant therapy (such as inversion, hydration and forced diuresis) were more effective than SWL therapy alone, with risk ratios (95% confidence intervals) of being stone free of: PNL 2.19 (1.62–2.96); URS 1.23 (1.03–1.48); and SWL with an adjuvant therapy 1.30 (1.03–1.63). However, patients treated with the other treatment methods also had a higher risk of adverse events (AEs) compared with SWL, but there was no evidence of a convincing difference between the various techniques and AEs. Conclusion In stones of <10 mm, SWL with an adjuvant therapy appears to have better stone clearance, lower risk of AEs, and need for further treatment. PNL was most effective treating larger stones, after considering both effectiveness and safety of treatment. These should be considered by both physicians and patients alike when considering the choice of treatment and in the revision of clinical practice guidelines.

Outcome of Percutaneous Nephrolithotomy in the Management of Lower Pole Stones

“…17 Despite its slight invasiveness, of all the treatment options, PCNL delivers the stone free rate more than 90% for lower pole stones >20mm. [18][19][20][21] In the present study, the overall stone free rate for PCNL in six weeks was 92.6% for stone size less than 20mm and 90.7% for stone size >20mm which was comparable to the stone free rate in the series by Netto et al and Cass AS. 22,23 The study also showed that the stone free rate in relation to stone size was not statistically significant ( P value o.78).…”

Comparative analysis of retrograde intrarenal surgery and modified ultra-mini percutaneous nephrolithotomy in management of lower pole renal stones (1.5–3.5 cm)

“…The treatment of lower pole renal calculi is a difficult point in urology. As the anatomical structure of the lower calyceal is not conducive for stone excretion, ESWL is less effective in the treatment of LPSs [1,16,17]. Some surgeons believed that either RIRS or PCNL surgery is needed even if the diameter of LPSs is less than 1.0 cm [18].…”

Comparative analysis of retrograde intrarenal surgery and modified Ultra-mini percutaneous nephrolithotomy in management of lower pole renal stones (1.5-3.5 cm)

“…The treatment of lower pole renal calculi is a difficult point in urology. As the anatomical structure of the lower calyceal is not conducive for stone excretion, ESWL is less effective in the treatment of LPSs [1, 16,17]. Some surgeons believed that either RIRS or PCNL surgery is needed even if the diameter of LPSs is less than 1.0 cm [18].…”