scholarly journals Efficacy and safety of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of large renal stones: a meta-analysis

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052098313
Author(s):  
Tie Mao ◽  
Na Wei ◽  
Jing Yu ◽  
Yinghui Lu
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Percutaneous Nephrolithotomy ◽  
Meta Analysis ◽  
Renal Stones ◽  
Efficacy And Safety ◽  
Complementary Treatment ◽  
Laparoscopic Pyelolithotomy ◽  
Stone Free Rate ◽  
Free Rate

Background We aimed to compare the efficacy and safety of laparoscopic pyelolithotomy (LPL) versus percutaneous nephrolithotomy (PCNL) for treating renal stones larger than 2 cm. Methods We searched the PubMed, Embase, Web of Science, SinoMed, and Chinese National Knowledge Infrastructure databases for studies that compared the surgical outcomes of LPL and PCNL. We conducted a meta-analysis of the retrieved studies, expressed as weighted mean difference or risk ratios with 95% confidence intervals. Results We included 25 studies (1831 patients). LPL was associated with a significantly higher stone-free rate, lower rates of blood loss, complementary treatment, blood transfusion, and complications, and less reduction in hemoglobin level compared with PCNL. LPL and PCNL were similar in terms of duration of hospital stay, conversion rate, changes in glomerular filtration rate and creatinine level, and mean time of postoperative analgesia. However, LPL was associated with a longer operation time than PCNL. Conclusion LPL appears to be more effective and safer than PCNL in patients with large renal stones, by increasing the stone-free rate and reducing blood loss, complementary treatment, blood transfusion, and complications compared with PCNL. LPL may thus be a useful modality for treating patients with large renal stones.

Ultrasonographic versus Fluoroscopic Access for Percutaneous Nephrolithotomy: A Meta-Analysis

2015 ◽  
Vol 95 (1) ◽  
pp. 15-25 ◽  
Author(s):  
Kun Wang ◽  
Peijin Zhang ◽  
Xianlin Xu ◽  
Min Fan
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Percutaneous Nephrolithotomy ◽  
Meta Analysis ◽  
Biomedical Literature ◽  
Controlled Trials ◽  
Intraoperative Blood Loss ◽  
Stone Free Rate ◽  
Operative Complications ◽  
Free Rate

Objective: To assess the safety and efficacy of ultrasonographic vs. fluoroscopic access for percutaneous nephrolithotomy (PCNL). Methods: Medline (PubMed), Embase, Ovid, Cochrane, and the Chinese Biomedical Literature databases were searched to identify clinically controlled trials (CCTs) and randomized controlled trials (RCTs) that compared ultrasonographic access with fluoroscopic access for PCNL. RevMan 5.1 software and Stat Manager V4.1 software were used for the meta-analysis. Results: Five RCTs and nine CCTs were included in our study, which contained a total of 3,019 patients. Of these, 1,574 (52%) had undergone ultrasonographic access, and 1,445 (48%) had undergone fluoroscopic access. The pooled results revealed that the ultrasonographic access patients had shorter duration of access (min) by 2.56 min (weighted mean difference (WMD) = −2.56, 95% confidence interval (CI): −4.40 to −0.72, p = 0.006). There was a higher stone-free rate in the ultrasonographic access group (odds ratio (OR) = 1.26, 95% CI: 1.02-1.55, p = 0.03), as well as a lower rate of operative complications (OR = 0.72, 95% CI: 0.56-0.93, p = 0.01), reduced intraoperative blood loss (ml) (WMD = −14.55 ml, 95% CI: −27.65 to −1.46, p = 0.03), and a lower rate of blood transfusion requirement (OR = 0.39, 95% CI: 0.24-0.63, p = 0.0001). Sensitivity and subgroup analyses were also performed. Conclusion: Except for no radiation exposure, our meta-analysis revealed that ultrasonographic access had many advantages, such as a shorter access time, reduced intraoperative blood loss, a lower rate of operative complications, a lower rate of blood transfusion, and a higher stone-free rate. Because of these significant advantages, we recommend the use of ultrasonographic access for PCNL.

Percutaneous nephrolithotomy of staghorn renal stones in pediatric patients using adult-sized instrument

2019 ◽  
Vol 86 (4) ◽  
pp. 211-215
Author(s):  
Akbar Nouralizadeh ◽  
Hamid Pakmanesh ◽  
Abbas Basiri ◽  
Mohammad Hadi Radfar ◽  
Behzad Narouie ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Pediatric Patients ◽  
Renal Stones ◽  
Adult Size ◽  
Efficacy And Safety ◽  
Double J Stent ◽  
Stone Free Rate ◽  
The Mean ◽  
Free Rate ◽  
Free Status

Introduction: In this study, we aimed to evaluate the safety and efficacy of the percutaneous nephrolithotomy procedure performed with adult-sized instruments in pediatric cases with staghorn kidney stone. Methods: We retrospectively evaluated the efficacy and safety of 94 percutaneous nephrolithotomy procedures performed during 15 years in a single center for 82 pediatric patients with staghorn calculi using adult-sized instruments (24-Fr nephroscope). Stone free status was defined as complete clearance of the stones or the presence of insignificant residual stones of <3 mm in diameter. Results: The mean age was 108 ± 53 months (range, 14–180 months). There were 39 patients (48%) with complete staghorn stones and 43 cases (52%) with partial staghorn. We fulfilled 91.4% of operations through a single access. The stone free rate was 86.6% after one percutaneous nephrolithotomy session. In total, seven patients referred for shock wave lithotripsy and four cases were scheduled for the second percutaneous nephrolithotomy session. Fever occurred in 18 patients (21%) and bleeding requiring transfusion in four children (5%). Prolonged leakage from nephrostomy site requiring anesthesia for double J stent placement occurred in one patient. No grade IV or V Clavien complication occurred. Conclusion: The success rate and complications of percutaneous nephrolithotomy with adult-size instruments in pediatric patients are acceptable.

Comparison of safety and efficacy of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in patients with large renal pelvic stones: a meta-analysis

2016 ◽  
Vol 64 (6) ◽  
pp. 1134-1142 ◽  
Author(s):  
Xuefang Rui ◽  
Haiyi Hu ◽  
Yanlan Yu ◽  
Shicheng Yu ◽  
Zhigen Zhang
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Publication Bias ◽  
Percutaneous Nephrolithotomy ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Renal Stones ◽  
Quality Analysis ◽  
Laparoscopic Pyelolithotomy

To compare percutaneous nephrolithotomy (PCNL) and laparoscopic pyelolithotomy (LP) for surgical management for large (>2 cm) renal stones. We searched MEDLINE, Cochrane, and EMBASE databases until March 11, 2015, using the following search terms: renalpelvic stone, percutaneous nephrolithotomy, laparoscopic pyelolithotomy. Randomized controlled and prospective and retrospective two-armed studies were included. Sensitivity analysis and assessment of the quality of the included studies and publication bias were performed. Nine studies were included in the study with a patient population of 622. The studies were homogeneous with respect to the primary end point of stone-free rate, but were heterogeneous with respect to operation time, length of hospital stay, and blood loss. A higher percentage of patients who received LP remained stone-free following surgery compared with patients who were treated with PCNL (p=0.001). However, the mean operation time was longer for patients with LP than for those treated with PCNL (p=0.002). There was no difference between procedures with regard to length of hospital stay or blood loss (p≥0.071). Sensitivity and quality analysis indicated that the data are reliable and the included studies are of good quality. No publication bias was observed. The study suggests that both procedures are effective and safe for removing large renal stones. However, LP may be more efficacious than PCNL in treating large kidney stones.

scholarly journals Standard versus Mini-Percutaneous Nephrolithotomy for Renal Stones: A Meta-Analysis

2020 ◽  
pp. 145749692092047
Author(s):  
J. Deng ◽  
J. Li ◽  
L. Wang ◽  
Y. Hong ◽  
L. Zheng ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Percutaneous Nephrolithotomy ◽  
Renal Pelvis ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Operation Time ◽  
Renal Stones ◽  
Cochrane Library ◽  
Stone Free Rate ◽  
Meta Analyses

Objective: To compare the standard percutaneous nephrolithotomy and mini-percutaneous nephrolithotomy in order to determine the optimal tract size for patients with renal stones. Methods: A systematic search of Web of Science, EMBASE, Cochrane Library, and PubMed databases was conducted for articles published through 20 August 2019, reporting on a comparison of the standard percutaneous nephrolithotomy and mini-percutaneous nephrolithotomy using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Of 763 studies, 14 were considered for the evidence synthesis. A total of 1980 cases were included. Of these patients, 897 cases underwent standard percutaneous nephrolithotomy, and 1083 cases underwent mini-percutaneous nephrolithotomy. Stone-free rates were 87.6% (786 of 897 patients) for standard percutaneous nephrolithotomy and 87.8% (951 of 1083 patients) for mini-percutaneous nephrolithotomy ( p = 0.57). Tract sizes of 30F and 22–26F in standard percutaneous nephrolithotomy group shorten operation time compared with mini-percutaneous nephrolithotomy ( p = 0.02; p = 0.004; respectively). Leakage ( p = 0.04), bleeding ( p = 0.01), blood transfusion ( p < 0.00001), and renal pelvis perforation ( p = 0.02) were more common in standard percutaneous nephrolithotomy group than in mini-percutaneous nephrolithotomy group. Subgroup analysis showed only blood transfusion for 30F and 22–26F standard percutaneous nephrolithotomy group was more common than mini-percutaneous nephrolithotomy ( p < 0.0001, p = 0.005, respectively). Conclusion: Standard percutaneous nephrolithotomy was associated with higher leakage, bleeding, blood transfusion, and renal pelvis perforation, but had a shorter operation time. Tract size of 30F improved the stone-free rate compared with mini-percutaneous nephrolithotomy, but led to more complications. Tract size of 22–26F was no better than 30F or mini-percutaneous nephrolithotomy.

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

2020 ◽  
Author(s):  
Dong Hyuk Kang ◽  
Kang Su Cho ◽  
Doo Yong Chung ◽  
Won Sik Jeong ◽  
Hae Do Jung ◽  
...  
Keyword(s):  
Systematic Review ◽  
Percutaneous Nephrolithotomy ◽  
Meta Analysis ◽  
Renal Stones ◽  
Research Quality ◽  
Observational Research ◽  
Success Rates ◽  
Retrograde Intrarenal Surgery ◽  
Stone Free Rate ◽  
Free Rate

Abstract 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.

scholarly journals Factors Affecting Transfusion During Percutaneous Nephrolithotomy: A Retrospective Study of 665 Cases

2021 ◽  
Author(s):  
Hong Zhao ◽  
Jun-Sheng Li ◽  
Li Li ◽  
Hang Wang ◽  
Yi Miao ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Percutaneous Nephrolithotomy ◽  
Open Surgery ◽  
Transfusion Rate ◽  
Preoperative Hemoglobin ◽  
Stone Burden ◽  
Stone Free Rate ◽  
History Of ◽  
Stone Type ◽  
Free Rate

Abstract Purpose: To evaluate the aspects affecting transfusion following percutaneous nephrolithotomy (PCNL).Background: From 2016 to 2019, 665 patients underwent PCNL for removal of renal calculi in our center. Complications, including hemorrhages, have been reported. Twenty-three patients (3.5%) have received a blood transfusion and twelve (1.9%) were treated by hyper-selective embolization. We focus on the influencing factors related to postoperative blood transfusion. The factors analyzed were (age, sex, hypertension, diabetes, serum creatinine level, preoperative hemoglobin, and use of anticoagulants or antiplatelet medications); renal and stone factors (previous surgery, abnormal anatomy, stone side, stone burden, stone type); and surgical features: (access number, the calyx of puncture and stone-free rate). These data were analyzed for the presence of bleeding.Results: Among individual factors, preoperative hemoglobin level (P<0.001), and urinary infection (P<0.001) were significantly correlated with blood transfusion. Among renal and stone factors, only previous history of open surgery was significantly correlated with blood transfusion (P<0.05). Stone type or stone burden does not correlate with transfusion. There was also no statistically significant correlation between surgical features and bleeding, and a lower stone-free rate reported for transfusion group.Conclusion: The obtained results demonstrated that PCNL is a safer surgery in a high volume center, but anemic conditions, infections and history of open surgery will significantly increase transfusion rate following PCNL.

Counter-Irrigation as a Novel Technique versus the Standard Technique in Percutaneous Nephrolithotomy: A Prospective Randomized Trial

2021 ◽  
pp. 1-7
Author(s):  
Ahmed El-Sakka ◽  
Abdelnaser Elgamasy ◽  
Karim Sallam ◽  
Mohamed G. Soliman
Keyword(s):  
Blood Transfusion ◽  
Hospital Stay ◽  
Randomized Trial ◽  
Percutaneous Nephrolithotomy ◽  
Standard Technique ◽  
Prospective Randomized Trial ◽  
Stone Free Rate ◽  
Group A ◽  
Group B ◽  
Free Rate

<b><i>Objective:</i></b> This study aimed to evaluate the efficacy of our counter-irrigation technique versus the standard technique in percutaneous nephrolithotomy (PCNL) by assessment of the stone-free rate after the procedures and its safety in terms of comparing the intraoperative time, Hb deficit, blood transfusion, length of hospital stay, auxiliary procedures, and perioperative complications with that of the standard one. <b><i>Methods:</i></b> This prospective randomized trial was conducted on patients with renal stone 2–3 cm in diameter without contraindications to PCNL. The patients were randomized into group A in which the counter-irrigation technique has been performed and group B who were managed by the standard technique. The preoperative characteristics including demographic data and stone parameters were compared between both groups. The primary outcome was the stone-free rate assessed by noncontrast spiral CT after 3 months. The secondary outcome included intraoperative time, Hb deficit, blood transfusion, hospital stay, auxiliary procedure required, and rate of complications. <b><i>Results:</i></b> Forty-eight patients were included in this study. Overall, no significant difference was observed between both groups regarding preoperative characteristics, Hb deficit, and complication rate. Operative time was significantly shorter in group B (<i>p</i> = 0.001). None of our patients required blood transfusion. The stone-free rates at 3 months were significantly better in group A (95% for group A and 70% for group B, <i>p</i> = 0.04). <b><i>Conclusions:</i></b> Our results indicate that our counter-irrigation technique has lower stone migration with subsequent significantly better stone-free rate versus the standard technique. We can recommend this technique as a potentially valid option for cases with large stone burden when the access to the upper calyx is feasible to minimize significant residual fragments.

scholarly journals Percutaneous nephrolithotomy versus open surgery for treatment of staghorn stones in pediatric patients

2014 ◽  
Vol 8 (11-12) ◽  
pp. 906 ◽  
Author(s):  
Ahmed R. EL-Nahas ◽  
Ahmed A Shokeir ◽  
Ahmed M Shoma ◽  
Ibrahim Eraky ◽  
Osama M Sarhan ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Open Surgery ◽  
Renal Stones ◽  
Small Sample ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Group 2 ◽  
Free Rate ◽  
Staghorn Stones

Introduction: We compare percutaneous nephrolithotomy (PCNL) and open surgery in the treatment of staghorn stones in children.Methods: We retrospectively reviewed the electronic records of children who underwent treatment for staghorn stones between September 2000 and August 2013. They were divided between Group 1 (patients who underwent PCNL) and Group 2 (patients who underwent open surgery). We compared stone-free and complications rates, need for multiple procedures, and hospital stay.Results: The study included 41 patients (35 boys and 6 girls), with mean age 7.4 ± 3.1 years (range: 2–15). Of these 41 patients, 26 had unilateral renal stone and 15 had bilateral renal stones. The total number of treated renal units was 56: 28 underwent PCNL and 28 underwent open surgery. The complication rate was comparable for both groups (32% for open surgery vs. 28.6%, p = 0.771). Multiple procedures were more needed in PCNL group (60.7% vs. 32% in open surgery, p = 0.032). The stone-free rate was 71.4% after PCNL and 78.6% after open surgery (p = 0.537). A significant difference was observed in shorter hospital stay after PCNL (5 vs. 8.8 days, p < 0.001). Our study’s limitations include its retrospective design and relatively small sample size.Conclusions: For the treatment of staghorn stones in children, PCNL was comparable to open surgery in complication and stone-free rates. PCNL had the advantage of a shorter hospital stay and open surgery showed a decreased need for multiple procedures. 

scholarly journals Differences Effectiveness of Percutaneous Nephrolithotomy and Open Surgery in Staghorn Stone Patients: Systematic Review

2020 ◽  
Vol 4 (11) ◽  
pp. 381-385
Author(s):  
Ramandita Duta Dewangga ◽  
Tarmono Djojodimedjo ◽  
Dyah Erawati
Keyword(s):  
Systematic Review ◽  
Percutaneous Nephrolithotomy ◽  
Open Surgery ◽  
Meta Analysis ◽  
Number Of Patients ◽  
Stone Free Rate ◽  
Additional Therapy ◽  
Staghorn Stone ◽  
Free Rate ◽  
Staghorn Stones

This study purpose to analyze the differences in the effectiveness of PCNL and open surgery in patients with staghorn stones. We searched the literatures from PubMed and ScienceDirect from year 2005 until 2020. The method used in this study was a systematic review with a quantitative statistical approach (meta-analysis) using primary research data. From 4 studies there were 148 cases of PCNL and 98 cases of open surgery. PCNL had lower postoperative stone-free rate than open surgery (OR 0.168). PCNL had a lower final stone-free rate than open surgery (OR 0.603). The number of patients who had complications with PCNL was lower than open surgery (OR 0.451). The number of patients receiving blood transfusions on PCNL was lower than for open surgery (OR 0.494). Patients who received PCNL procedure required a shorter hospital stay than open surgery (MD -3,234). The number of patients who received additional therapy modalities on PCNL was lower than open surgery (OR 1.917). The conclusions obtained in this study indicate that there are differences in the effectiveness of PCNL and open surgery for patients with staghorn stones. Keywords: percutaneous nephrolithotomy; open surgery; staghorn stone

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