The Impact of Lasers in Percutaneous Nephrolithotomy Outcomes: Results from a Systematic Review and Meta-Analysis of Randomized Comparative Trials

Castellani, Daniele; Corrales, Mariela; Lim, Ee Jean; Cracco, Cecilia Maria; Scoffone, Cesare Marco; Teoh, Jeremy Yuen Chun; Traxer, Olivier; Gauhar, Vineet

doi:10.1089/end.2021.0507

Cited by 9 publications

(3 citation statements)

References 23 publications

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“…Our findings suggest that a tailored and personalized approach is the need of the day for modern PCNL, and urologists should not shy away from using bigger tracts to achieve a good outcome [ 37 ]. Significant advancements in miniaturization [ 36 ], adoption of new positions [ 38 ], and technological enhancements have provided a plethora of choices for lithotripsy, ranging from ballistic to laser to combined energy devices [ 39 ]. The aforementioned improvements tackle any stone composition and volume, with minimal complications and maximum efficacy, making PCNL feasible for a day surgery/ambulatory procedure in a select group of patients.…”

Section: Discussionmentioning

confidence: 99%

Complications and outcomes of tubeless versus nephrostomy tube in percutaneous nephrolithotomy: a systematic review and meta-analysis of randomized clinical trials

et al. 2022

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We aimed to perform a systematic review of randomized trials to summarize the evidence on the safety and stone-free rate after Tubeless percutaneous nephrolithotomy (PCNL) (ureteral stent/catheter, no nephrostomy) compared to Standard PCNL (nephrostomy, with/without ureteral stent/catheter) to evaluate if the tubeless approach is better. The inverse variance of the mean difference with a random effect, 95% Confidence Interval (CI), and p values was used for continuous variables. Categorical variables were assessed using Cochran–Mantel–Haenszel method with the random effect model, and reported as Risk Ratio (RR), 95% CI, and p values. Statistical significance was set at p < 0.05 and a 95% CI. 26 studies were included. Mean operative time was significantly shorter in the Tubeless group (MD—5.18 min, 95% CI − 6.56, − 3.80, p < 0.00001). Mean postoperative length of stay was also significantly shorter in the Tubeless group (MD—1.10 day, 95% CI − 1.48, − 0.71, p < 0.00001). Incidence of blood transfusion, angioembolization for bleeding control, pain score at the first postoperative day, the number of patients requiring postoperative pain medication, fever, urinary infections, sepsis, perirenal fluid collection, pleural breach, hospital readmission, and SFR did not differ between the two groups. Incidence of postoperative urinary fistula was significantly lower in the Tubeless group (RR 0.18, 95% CI 0.07, 0.47, p = 0.0005). This systematic review shows that tubeless PCNL can be safely performed and the standout benefits are shorter operative time and hospital stay, and a lower rate of postoperative urinary fistula.

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Section: Discussionmentioning

confidence: 99%

Complications and outcomes of tubeless versus nephrostomy tube in percutaneous nephrolithotomy: a systematic review and meta-analysis of randomized clinical trials

et al. 2022

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“…The predictors of postoperative stone-free status (SFS) and complications are the most researched subjects regarding the percutaneous nephrolithotomy (PNL) procedure. [1][2][3] To date, several factors including access technique, patient position, size of nephroscope, stone characteristics (ie, size, density, number and localisation), patient characteristics (ie, body mass index [BMI], previous stone surgery, anatomical disorder, comorbidity), annual case volume (ACV) in the hospital have been implicated in predicting SFS and complications and even various scoring systems…”

Section: Introductionmentioning

confidence: 99%

Endourologists vs urologists: The impact of surgical experience and annual case volume on percutaneous nephrolithotomy outcomes

Sahin,

Yilmaz

et al. 2023

Scripta Medica

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Background/Aim: Surgeon experience, which is an important factor in reducing surgical complications, has been underestimated when analysing percutaneous nephrolithotomy (PNL) outcomes. Aim of this study was to investigate the impact of annual case volume (ACV) of endourologists and urologists on PNL outcomes including stone-free status (SFS) and complications. Methods: A total of 530 patients who underwent PNL in the Clinic between January 2018 and January 2023 were retrospectively analysed. The patients were divided into two groups: those operated by endourologists (Group 1, n = 324) and by urologists (Group 2, n = 206). The two groups were statistically compared in terms of postoperative SFS and complications. Results: There were two endourologists in Group 1 and four urologists in Group 2. The mean ACV was 73.56 ± 7.43 in Group 1 and 23.81 ± 9.09 in Group 2, indicating a statistically significantly higher rate in Group 1 (p < 0.001). There was no statistically significant difference in the postoperative SFS rates between the groups (p = 0.064). In the perioperative period, the mean estimated blood loss and nephrostomy dwell time were significantly lower in Group 1 than Group 2 (p = 0.013 and p = 0.008, respectively). In the logistic regression analysis, a cut-off value of > 24 for ACV and CROES scores were the significant predictors of SFS (p = 0.004 and p < 0.001, respectively). The complication rate was significantly lower among surgeons with an ACV of > 24 (p < 0.001). Conclusion: Results from this study showed that an ACV of > 24 increases SFS rate by 2.13 with lower complication rates in patients undergoing PNL. Further multi-centre, large-scale studies are required to investigate the effect of surgical experience and ACV on postoperative outcomes and to predict PNL outcomes with high accuracy.

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“…The Holmium:yttrium-aluminum-garnet (Ho:YAG) laser is currently widely accepted as the gold standard laser lithotripter [2]. Interestingly, a recent meta-analysis of lasers in PNL concluded that nonlaser PNL had better perioperative outcomes and stone free rates (SFR) than its laser counterpart [3 ▪▪ ].…”

Section: Introductionmentioning

confidence: 99%

Lithotripsy devices for percutaneous nephrolithotomy (PNL) – new developments

Antoniou

Pietropaolo

Somani

2022

Current Opinion in Urology

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Purpose of reviewPercutaneous nephrolithotomy (PNL) is the mainstay of surgery for renal calculi>2 cm or complex multiple calculi and is a technique that has been around since 1976. We review recent literature surrounding novel lithotripsy devices and technology used in PNL. Recent findingsAt present, the Holmium:yttrium-aluminum-garnet (Ho:YAG) laser is widely accepted as the gold standard laser lithotripsy for PNL. SwissLithoClast Trilogy offers a range of probes with a trifecta of electromagnetic, ultrasonic energy with surgeon-controlled suction. The Olympus Shockpulse-SE is a similar lithotripter that relies on continuous ultrasonic energy with pulsed ballistic energy to break stones. Thulium Fiber Laser (TFL) offers an alternative laser energy source to the Holmium laser, which has been shown to be very effective at producing small stone fragments and dust. The Moses technology is another addition in a long list of improvements to the Ho:YAG laser, forming vaporization bubble through which more effective energy can be applied to stones. SummaryTrilogy, Shockpulse, TFL and Moses pulse modulation technology for the Holmium laser all provide improvements compared with older lithotripsy devices. In particular, they convey a safer, efficient and more effective way to manage and clear stones.

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The Impact of Lasers in Percutaneous Nephrolithotomy Outcomes: Results from a Systematic Review and Meta-Analysis of Randomized Comparative Trials

Cited by 9 publications

References 23 publications

Complications and outcomes of tubeless versus nephrostomy tube in percutaneous nephrolithotomy: a systematic review and meta-analysis of randomized clinical trials

Complications and outcomes of tubeless versus nephrostomy tube in percutaneous nephrolithotomy: a systematic review and meta-analysis of randomized clinical trials

Endourologists vs urologists: The impact of surgical experience and annual case volume on percutaneous nephrolithotomy outcomes

Lithotripsy devices for percutaneous nephrolithotomy (PNL) – new developments

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