Comparison of vacuum-assisted sheaths and normal sheaths in minimally invasive percutaneous nephrolithotomy: a systematic review and meta-analysis

Abstract

Background A systematic review and meta-analysis was conducted to compare the safety and efficacy of vacuum-assisted sheaths and conventional sheaths in minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of nephrolithiasis. Methods PubMed, Web of Science, Embase, EBSCO, and Cochrane Library databases (updated March 2021) were used to search for studies assessing the effect of vacuum-assisted sheaths in patients who underwent MPCNL. The search strategy and study selection processes were implemented in accordance with the PRISMA statement. Result Three randomized controlled trials and two case-controlled trials that satisfied the inclusion criteria were enrolled in this meta-analysis. Overall, the stone-free rate (SFR) in patients who underwent vacuum-assisted sheaths was significantly higher than that in patients who underwent conventional sheaths (RR 1.23, 95% CI 1.04, 1.46, P = 0.02), with significant heterogeneity among the studies (I2 = 72%, P = 0.03). In terms of the outcome of complications, vacuum-assisted sheath could bring a benefit to the postoperative infection rate (RR 0.48, 95% CI 0.33, 0.70, P < 0.00001) with insignificant heterogeneity among the studies (I2 = 0%, P = 0.68). There was no significant difference in the blood transfusion rate (RR 0.35, 95% CI 0.07, 1.73, P = 0.17), with significant heterogeneity (I2 = 66%, P = 0.35). Three studies contained operative time data, and the results indicated that the vacuum-assisted sheath led to a shorter operative time (MD = − 15.74; 95% CI − 1944, − 12.04, P < 0.00001) with insignificant heterogeneity (I2 = 0%, P = 0.91). Conclusion The application of a vacuum-assisted sheath in MPCNL improves the safety and efficiency compared to the conventional sheath. A vacuum-assisted sheath significantly increases the SFR while reducing operative time and postoperative infection.

A retrospective comparison of Sun’s tip-flexible semirigid ureterorenoscopy, super-mini percutaneous nephrolithotomy and flexible ureteroscopy applied to treat upper urinary tract calculi

“…As SN-V, SN-V1 and SN-V2 generation tf-URS equipped without a flexible ureteroscope sheath, the back-flow of lavage fluid decreased with high intrapelvic pressure [ 3 ]. When the intrapelvic pressure exceeds 30 mmHg, intrarenal backflow would occur and cause infection [ 18 ]. For patients with infection, it is advised to place double J stent two weeks before surgery when the infection is well controlled [ 19 ].…”

Validation of the Trifecta Scoring Metric in Vacuum-Assisted Mini-Percutaneous Nephrolithotomy: A Single-Center Experience

“…Lievore et al found lower rates of infectious complications, shorter OT, and reduced radiation exposure in 104 patients treated with vmPCNL compared to 52 patients who underwent miniPCNL [8]. Recently, a meta-analysis conducted by Zhu et al demonstrated an improvement in safety and efficiency in procedures with a vacuum-assisted sheath compared to those with a conventional sheath [20]. These results highlighted higher SFR while reducing operative time and postoperative infection by using vacuum-assisted technology.…”

Prevalence and predictors of unfavourable risk factors of trifecta in vacuum assisted mini- percutaneous nephrolithotomy: a single center experience

“…Lievore et al found lower rates of infectious complications, shorter OT and reduced patient's effective dose in 104 patients treated with vamPCNL as compared to 52 patients who underwent miniPCNL [8]. Recently, a meta-analysis conducted by Zhu et al demonstrated an improvement in safety and e ciency in procedures with vacuum-assisted sheath compared to those with conventional sheath [20]. These results highlighted higher SFR while reducing operative time and postoperative infection by using vacuum-assisted technology.…”