Systematic review and meta-analysis to compare success rates of retrograde intrarenal surgery versus percutaneous nephrolithotomy for renal stones >2 cm

Abstract

Background:We performed a systematic review and meta-analysis comparing stone-free rates between retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL), using updated, more reliable evidence.Materials and methods:Randomized controlled trials comparing RIRS and PCNL for >2 cm 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 (RRs) with 95% confidence intervals (CIs).Results:Eleven articles were included in this study. Most recently published studies exhibited relatively low quality during quality assessment. For the meta-analysis comparing success (stone-free) rates between PCNL and RIRS, the forest plot using the random-effects model showed an RR of 1.11 (95% CI 1.02–1.21, P < .014) favoring PCNL. After determining the among-study heterogeneity, subgroup analysis was performed of 9 studies with less heterogeneity: the stone-free rate of PCNL was superior to that of RIRS using a fixed-effect model (RR 1.07, 95% CI 1.01–1.14, P < .019) for these studies.Conclusions:RIRS can be a safe and effective procedure for selected patients with large renal stones. However, in this meta-analysis, the postoperative stone-free rate of PCNL was higher than that of RIRS in patients with >2 cm renal stones.

Percutaneous nephrolithotomy vs. retrograde intrarenal surgery for renal stones larger than 2cm in patients with a solitary kidney: A systematic review and a meta-analysis

“…Therefore, RIRS has been adopted as the preferred choice of management of kidney stones because of its low complication rate, especially for solitary kidney patients. Moreover, multiple studies demonstrated RIRS as an efficient and safe procedure which could be utilized to manage kidney stones in with solitary kidney patients [3,8,9,11]. From the study of 29 RIRS patients who were treated with renal stones by Giusti G et al…”

“…However, with advancing minimally invasive technology, RIRS is progressively being utilized as the best alternative therapy to PCNL for managing kidney stones owing to negligible complications. For solitary kidney patients, RIRS plays an essential role in preserving renal parenchyma [3,8,9]; nevertheless, lower SFR has been reported for large kidney stones [3,[8][9][10][11].…”

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

“…In 2017, Kang et al reported a systematic review and meta-analysis, in which updated evidence of stone-free rates of RIRS and PCNL in > 2-cm renal stones were compared with a previous report [54]. In their meta-analysis comparing the success (stone-free) rates between PCNL and RIRS, the forest plot using the random-effects model showed a risk ratio of 1.11 (95% CI: 1.02-1.21; p = .01) favoring PCNL.…”

“…In 2014, Zheng et al reported no difference between RIRS and PCNL in > 2-cm renal stones using meta-analysis [55]. Kang et al concluded that their meta-analysis was performed using three additional articles compared with Zheng et al, and all three additional studies reported stone-free rates with RIRS that were relatively lower than those seen with PCNL [54]. Zhang et al…”

Real-time simultaneous endoscopic combined intrarenal surgery with intermediate-supine position: Washout mechanism and transport technique

“…Among these three interventional treatments, PCNL is currently the most effective treatment option for renal stone >2 cm [2]. In the European Association of Urology Urolithiasis Guidelines, ESWL and RIRS are recommended as first-line treatment for renal stone <2 cm in length, and PCNL is recommended as a first-line treatment for renal stone ≥2 cm [3].…”