Minimally Invasive Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery for Upper Urinary Stones: A Systematic Review and Meta-Analysis

Jiang, Hongyang; Yu, Zhe; Chen, Liping; Wang, Tao; Liu, Zhuo; Liu, Jihong; Wang, Shaogang; Ye, Zhangqun

doi:10.1155/2017/2035851

Cited by 35 publications

(19 citation statements)

References 37 publications

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“…The surgical outcomes of miniaturized PCNL are promising, with good SFRs, shorter hospital stay and reduced risk of morbidity, such as bleeding, adjacent organ injury and so on (LE:1) . Miniaturized PCNL and RIRS have similar indications for medium‐sized renal stones <3 cm; however, safety concerns regarding the higher bleeding risk, larger hemoglobin drop or longer hospital stay of miniaturized PCNL compared with RIRS arose (LE:1) …”

Section: Clinical Questions and Answersmentioning

confidence: 99%

“…186 Miniaturized PCNL and RIRS have similar indications for medium-sized renal stones <3 cm; 188 however, safety concerns regarding the higher bleeding risk, larger hemoglobin drop or longer hospital stay of miniaturized PCNL compared with RIRS arose (LE:1). 189,190 Bidirectional bilateral approach CQ 28. What is the algorithm for treatment of adult patients with symptomatic renal stones?…”

Section: Commentarymentioning

confidence: 99%

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The Urological Association of Asia clinical guideline for urinary stone disease

et al. 2019

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The Urological Association of Asia, consisting of 25 member associations and one affiliated member since its foundation in 1990, has planned to develop Asian guidelines for all urological fields. The field of stone diseases is the third of its guideline projects. Because of the different climates, and social, economic and ethnic environments, the clinical practice for urinary stone diseases widely varies among the Asian countries. The committee members of the Urological Association of Asia on the clinical guidelines for urinary stone disease carried out a surveillance study to better understand the diversity of the treatment strategy among different regions and subsequent systematic literature review through PubMed and MEDLINE database between 1966 and 2017. Levels of evidence and grades of recommendation for each management were decided according to the relevant strategy. Each clinical question and answer were thoroughly reviewed and discussed by all committee members and their colleagues, with suggestions from expert representatives of the American Urological Association and European Association of Urology. However, we focused on the pragmatic care of patients and our own evidence throughout Asia, which included recent surgical trends, such as miniaturized percutaneous nephrolithotomy and endoscopic combined intrarenal surgery. This guideline covers all fields of stone diseases, from etiology to recurrence prevention. Here, we present a short summary of the first version of the guideline – consisting 43 clinical questions – and overview its key practical issues.

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Section: Clinical Questions and Answersmentioning

confidence: 99%

Section: Commentarymentioning

confidence: 99%

The Urological Association of Asia clinical guideline for urinary stone disease

et al. 2019

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“…The stone-free rate is mainly correlated with the stone burden; however, most importantly, differences have been reported between different procedures [52]. The stone-free rate is the most important parameter to estimate the e cacy of all the approaches [53]. According to previous reports, PCNL and mPCNL have a higher stone-free rate than RIRS, although various imaging modalities were used.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the stone-free rates of mini-percutaneous nephrolithotomy, standard percutaneous nephrolithotomy, and retrograde intrarenal surgery for renal stones: A systematic review and network meta-analysis

Kang¹,

Chung

Jeong

et al. 2020

Preprint

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Background: Retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are performed to treat renal stones. PCNL is effective for kidney stones >2 cm but is invasive compared with RIRS. Miniature PCNL (mPCNL) has been used as an alternative treatment for conventional PCNL, and employs a miniature endoscope of 11–18 Fr. We conducted a systematic review of published studies regarding the RIRS, PCNL, and mPCNL treatment modalities, and performed a network meta-analysis of the success or stone-free rates.Methods: The data collected up to January 2016 were searched using PubMed and EMBASE, and references were searched electronically. Two researchers used data extraction formats to extract data on the stone-free or success rates, study design, number of subjects and characteristics, and treatments for renal stones (i.e., RIRS, PCNL, and mPCNL). To evaluate the quality of the studies, the Downs and Black checklist, which is an observational research quality evaluation tool, was used and analyzed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Results: Twenty-five studies were used to compare the stone-free or success rates of RIRS, PCNL, and mPCNL for renal stones. Six comparisons of PCNL and mPCNL, seven of mPCNL and RIRS, and 12 of RIRS and PCNL were analyzed. No difference in the stone-free rate was found between PCNL and mPCNL (OR: 0.95; 95% CI: 0.51–1.9) in network mata-analysis. Between RIRS and mPCNL, the stone-free rate of RIRS was lower than mPCNL (OR: 0.41; 95% CI: 0.021–0.82). Comparison of RIRS and PCNL revealed that RIRS was also lower than PCNL in terms of stone-free rate (OR: 0.43; 95% CI: 0.22–0.82). In the ranking analysis, rankogram showed that mPCNL was ranked as No. 1 and PCNL was ranked as No. 2. The P-score was 0.820 for mPCNL, 0.680 for PCNL and 0 for RIRS.Conclusions: PCNL and mPCNL showed higher success or stone-free rates than RIRS for the treatment of renal stones. However, PCNL and mPCNL showed no difference in the treatment outcome.

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“…Retrograde intrarenal surgery (RIRS) is another procedure for the treatment of upper urinary calculi. A high-quality meta-analysis showed that Miniperc provided signi cantly higher SFR compared with RIRS; however, Miniperc was accompanied with a higher incidence of postoperative complications [24].…”

Section: Discussionmentioning

confidence: 99%

“…We demonstrated that the hospital stay time of Microperc is shorter, although not statistically signi cant. The possible reason is that Microperc has less damage and less postoperative discomfort [24]. Besides, it carries a lower urinary tract infection rate and hemoglobin drop.…”

Section: Discussionmentioning

confidence: 99%

Micropercutaneous Versus Minipercutaneous for the Management of Moderately Sized Kidney Stones: A Systematic Review and Meta-Analysis

Gao¹,

Zhou²,

Wang³

et al. 2020

Preprint

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Background: To assess the efficacy and safety of mini-percutaneous nephrolithotomy (Miniperc) and micropercutaneous nephrolithotomy (Microperc) for moderately sized renal stones. Methods: Literature search of PubMed, Web of Science, and Embase was performed before January 2020. We used odds ratios (OR) and weighted mean difference (WMD) for dichotomous variables and continuous variables, respectively. Results were pooled by Review Manager version 5.3 software. Results: A total of 4 studies involving 172 Microperc and 162 Miniperc cases were included. The overall SFR of Microperc was 86.05% (148/172), while the SFR of the Miniperc was 87.65% (142/162). Microperc was associated with lower hemoglobin drop (WMD: -0.98; P = 0.03), higher renal colic requiring D-J stent insertion (OR: 3.49; P=0.01). No significant differences exist between Microperc and Miniperc with respect to stone-free rate (SFR) (OR: 0.90; P=0.75), urinary tract infection (OR: 0.38; P=0.18), operative time (WMD: 14.73; P = 0.54) and hospital stay time (WMD: -1.04; P=0.07). Conclusions: Our meta-analysis demonstrated that Microperc could obtain comparable SFR with Miniperc. Microperc was associated with lower hemoglobin drop, but Miniperc was associated with lower renal colic rates. In addition, the operation time and hospital stay time for these two procedures were similar.

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Minimally Invasive Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery for Upper Urinary Stones: A Systematic Review and Meta-Analysis

Cited by 35 publications

References 37 publications

The Urological Association of Asia clinical guideline for urinary stone disease

The Urological Association of Asia clinical guideline for urinary stone disease

Comparison of the stone-free rates of mini-percutaneous nephrolithotomy, standard percutaneous nephrolithotomy, and retrograde intrarenal surgery for renal stones: A systematic review and network meta-analysis

Micropercutaneous Versus Minipercutaneous for the Management of Moderately Sized Kidney Stones: A Systematic Review and Meta-Analysis

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