Comparison of stone-free rates following shock wave lithotripsy, percutaneous nephrolithotomy, and retrograde intrarenal surgery for treatment of renal stones: A systematic review and network meta-analysis

Abstract

Objectives To perform a systematic review and network meta-analysis comparing stone-free rates following retrograde intrarenal surgery (RIRS), extracorporeal shock wave lithotripsy (SWL), and percutaneous nephrolithotomy (PCNL) treatments of renal stones. Materials and methods Clinical trials comparing RIRS, SWL, and PCNL for treatment of renal stones were identified from electronic databases. Stone-free rates for the procedures were compared by qualitative and quantitative syntheses (meta-analyses). Outcome variables are shown as risk ratios (ORs) with 95% credible intervals (CIs). Results A total of 35 studies were included in this network meta-analysis of success and stone-free rates following three different treatments of renal stones. Six studies compared PCNL versus SWL, ten studies compared PCNL versus RIRS, fourteen studies compared RIRS versus SWL, and five studies compared PCNL, SWL, and RIRS. The quality scores within subscales were relatively low-risk. Network meta-analyses indicated that stone-free rates of RIRS (OR 0.38; 95% CI 0.22–0.64) and SWL (OR 0.12; 95% CI 0.067–0.19) were lower than that of PCNL. In addition, stone-free rate of SWL was lower than that of RIRS (OR 0.31; 95% CI 0.20–0.47). Stone free rate of PCNL was also superior to RIRS in subgroup analyses including ≥ 2 cm stone (OR 4.680; 95% CI 2.873–8.106), lower pole stone (OR 1.984; 95% CI 1.043–2.849), and randomized studies (OR 2.219; 95% CI 1.348–4.009). In rank-probability test, PCNL was ranked as No. 1 and SWL was ranked as No. 3. Conclusions PCNL showed the highest success and stone-free rate in the surgical treatment of renal stones. In contrast, SWL had the lowest success and stone-free rate.

A preoperative nomogram for sepsis in percutaneous nephrolithotomy treating solitary, unilateral and proximal ureteral stones

“…The treatment options for stone disease range from open surgery to endoscopic surgery, such as percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS) (Heinze, Gozen & Rassweiler, 2019). Generally, PCNL results in higher stone-free rate than URS, at the expense of elevated complication rate and prolonged hospital stays, without difference in secondary interventions (De et al, 2015;Chung et al, 2019). However, infection remains a main complication that can cause longer length of stay and even lethal sepsis shock (Kreydin & Eisner, 2013).…”

Association between ureteric stent dwell time and urinary tract infection

“…Additional medical management with selective alpha‐receptor antagonists in stones less than 10 mm diameter has demonstrated efficacy for promoting stone passage 4 . Despite these measures, 10–20% of urolithiasis will require surgical management with extracorporeal shock‐wave lithotripsy (ESWL), retrograde intrarenal surgery with ureteroscopy and laser lithotripsy or percutaneous nephrolithotomy (PCNL) 5 . Whilst ESWL is less invasive, laser lithotripsy can perform stone dusting and fragmentation under direct endoscopic vision; and has the added advantage of directly removing fragmented stones using a basket for stone analysis.…”

Is physical therapy effective following extracorporeal shockwave lithotripsy and retrograde intrarenal surgery: a meta-analysis and systematic review

“…When compared to PCNL, the SFR after ESWL and RIRS is getting increasingly concerned, since spontaneous passage of stone fragments following ESWL and RIRS is more required than PCNL. It has been reported that SFR ranges from 23.1 to 91.5% and 45.6 to 96.7% in ESWL and RIRS, respectively [12]. Residual stone fragments related complications are foreseeable, urinary tract infection, renal colic and steinstrasse are most common and might require additional intervention [13,14].…”