Retrograde Intrarenal Surgery versus Percutaneous Nephrolithotomy for Treatment of Renal Stones >2 cm: A Meta-Analysis

Abstract

Objective: To systematically review the efficacy and safety of retrograde intrarenal surgery (RIRS) versus percutaneous nephrolithotomy (PCNL) for the treatment of renal calculi >2 cm. Methods: We searched PubMed, Cochrane Library, Embase and the Chinese Biomedical Literature Database about RIRS and PCNL for the treatment of renal stones. The retrieval time ended in December 2013. All clinical trials were retrieved and their included references investigated. Two reviewers independently assessed the quality of all included studies, and the eligible studies were included and analyzed using the RevMan 5.2 software. Results: Two randomized controlled trials and six clinical controlled trials were included, involving a total of 590 patients. Our meta-analysis showed that there were not significant differences in stone-free rate (relative risk [RR] = 0.95, 95% confidence interval (CI) 0.88-1.02, p = 0.11) and fever (RR = 0.95, 95% CI 0.54-1.67, p = 0.85) between RIRS and PCNL. We found that hospital stay (weighted mean difference [WMD] = -2.10, 95% CI -3.08 to -1.11, p < 0.10) and bleeding (RR = 0.20, 95% CI 0.06-0.68, p = 0.01) were lower and operation time was longer (WMD = 19.11, 95% CI 7.83-30.39, p < 0.10) for RIRS. Conclusion: RIRS is a safe and effective procedure. It can successfully treat patients with stones >2 cm with a high stone-free rate and significantly reduce hospital stay without increasing complications. RIRS can be used as an alternative treatment to PCNL in selected cases with larger renal stones. However, further randomized trials are needed to confirm these findings.

Comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of renal stones greater than 2 cm

“…Similar to the literature results, hospital stay was significantly shorter in the RIRS group compared with the PCNL group (p<0.001). [24,28] The limitations of our study are its retrospective nature, small number of patients included, being a single-center study, and a short follow-up time. Because of the retrospective nature of our study, attention was focused on the diameter of the stone.…”

“…No studies in the current literature have investigated the relation between bleeding in RIRS and the duration of operation. [24] On the other hand, high intrarenal pressure during RIRS has been reported to cause temporary intrarenal reflux affecting the renal function. [15,25] A significant postoperative increase in creatinine was not seen in any of the patients included in the present study.…”

Percutaneous Nephrolithotomy Induced Renal Hemorrhage in a Patient with Bilateral Double Renal Arteries: A Case Report and Literature Review

“…As reported, the complete and relative success rates of PCNL were 89.4% and 10.6% [1], which provides overall significantly higher stone-free rates than retrograde intrarenal surgery (weighted mean difference: 2.19; 95% confidence interval, 1.53 -3.13) [5]. However, severe hemorrhage after percutaneous nephrolithotomy is a rare complication (less than 1%) but life-threatening event [6].…”

Risk Factors for Ureteral Damage in Ureteroscopic stone Treatment: Results of the German Prospective Multicentre Benchmarks of Ureterorenoscopic Stone Treatment-Results in Terms of Complications, Quality of Life, and Stone-Free Rates Project

“…Complete stone clearance and low therapy-associated morbidity are considered the optimal outcomes when treating urolithiasis by retrograde intrarenal surgery [1,2]. Thanks to extensive improvements in the endoscopic technology (smaller diameter, better visualisation), as well as lithotriptors and other assisting devices (guide wires, stone-capturing baskets), the role of ureteroscopy (URS) has grown dramatically in recent years and is now considered the standard therapy for stones measuring ≤2 cm in the upper urinary tract (UT) [3].…”