Effectiveness of Percutaneous Nephrolithotomy, Retrograde Intrarenal Surgery, and Extracorporeal Shock Wave Lithotripsy for Treatment of Renal Stones: A Systematic Review and Meta-Analysis

Abstract

Background and objectives: To perform a updated systematic review and meta-analysis comparing effectiveness of percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stones (RS). Materials and Methods: A total of 37 studies were included in this systematic review and meta-analysis about effectiveness to treat RS. Endpoints were stone-free rates (SFR), incidence of auxiliary procedure, retreatment, and complications. We also conducted a sub-analysis of ≥2 cm stones. Results: First, PCNL had the highest SFR than others regardless of stone sizes and RIRS showed a higher SFR than ESWL in <2 cm stones. Second, auxiliary procedures were higher in ESWL than others, and it did not differ between PCNL and RIRS. Finally, in <2 cm stones, the retreatment rate of ESWL was higher than others. RIRS required significantly more retreatment procedures than PCNL in ≥2 cm stones. Complication was higher in PCNL than others, but there was no statistically significant difference in complications between RIRS and PCNL in ≥2 cm stones. For ≥2 cm stones, PCNL had the highest SFR, and auxiliary procedures and retreatment rates were significantly lower than others. Conclusions: We suggest that PCNL is a safe and effective treatment, especially for large RS.

Should we support prophylactic intervention for asymptomatic kidney stones? A retrospective cohort study with long-term follow-up

“…In this study, the increase in stone size between the initial state and surgical intervention was much smaller in the exposure group than in the control group, confirming that prophylactic intervention can address stones when the stone size was relatively small. Slight complications were reported after most prophylactic interventions, but no patients required additional surgery for complications, consistent with other reports [ 25 – 27 ].…”

Massive Ureterolithiasis

“…While 94% of PCNL candidates were successful, only 76% of SWL patients had success. Although PCNL was the more effective technique in this study, it is the more invasive option as well [ 10 , 11 ]. This decision should be visited once the stone width and location suggest that spontaneous passage is unlikely.…”

Erector Spinae Plane Block for Perioperative Analgesia after Percutaneous Nephrolithotomy

“…PCNL is a highly efficacious procedure with stone-free rates exceeding 80% [9,10]. To date, it is considered the most effective treatment for large kidney stones, but drawbacks include higher blood loss, pain, and the complication rate in comparison with other forms of endourological treatment.…”