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

2019 ◽  
Author(s):  
Kehua Jiang ◽  
Guangheng Luo ◽  
Jianxing Hu ◽  
Jianguo Zhu ◽  
Fa Sun
Keyword(s):  
Blood Loss ◽  
Percutaneous Nephrolithotomy ◽  
Meta Analysis ◽  
Operation Time ◽  
Renal Stones ◽  
Solitary Kidney ◽  
Systematic Evaluation ◽  
Cochrane Library ◽  
Transfusion Rate ◽  
Retrograde Intrarenal Surgery

Abstract Background: The safety and feasibility of percutaneous nephrolithotomy (PCNL) compared with retrograde intrarenal surgery (RIRS) are debated. This systematic evaluation was performed to obtain comprehensive evidence with regard to the treatment outcomes of PCNL compared with RIRS for management of renal stones in patients with solitary kidney. Methods: A systematic search of Medline, Embase, Pubmed, and the Cochrane Library was performed to identify studies that compared PCNL with RIRS. Outcomes of interest included perioperative variables, complications, and stone-free rate (SFR). Results: 4 studies assessing PCNL vs. RIRS were included for meta-analysis. Although patients underwent PCNL have higher initial SFR than RIRS (OR: 3.72, 95% CI:2.38 to 5.83; P＜0.001), patients underwent RIRS have less intraoperative blood loss (dropped Hb: WMD= 3.49 g/L, 95% CI:2.83 to 4.15; P＜0.001), lower blood transfusion rates (OR= 5.31, 95% CI:1.36 to 20.68; P=0.02), and higher incidence rate of steinstrasse (OR:0.20, 95% CI:0.04 to 0.91; P=0.04). All the other calculated results including operation time (WMD: -9.87 minute, 95% CI:-30.11 to 10.37; P=0.34), final SFR (OR:1.65, 95% CI:0.80 to 3.42;P=0.18) and overall complications (OR:1.22, 95% CI:0.78 to 1.93; P=0.38) are similar between the two groups. Conclusions: Our results indicate that PCNL has higher initial SFR than RIRS in the treatment of renal stones in patients with a solitary kidney; the overall complications were comparable in both groups. However, RIRS, with less blood loss and transfusion rate, may be an alternative in selected patients.

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.

Retrograde Intrarenal Surgery versus Percutaneous Nephrolithotomy in the Treatment of Solitary Kidney Calculi: a Meta-Analysis

2020 ◽  
Author(s):  
LuJie Qian ◽  
YuLi Jiang ◽  
ZePeng Jiang ◽  
YanJuan Li ◽  
JiaNan Xiang
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Data Extraction ◽  
Meta Analysis ◽  
Management Strategies ◽  
Operation Time ◽  
Solitary Kidney ◽  
Kidney Calculi ◽  
Retrograde Intrarenal Surgery ◽  
Major Complications ◽  
The Difference

Abstract Background: To assess the effectiveness and safety of retrograde intrarenal surgery(RIRS) and percutaneous nephrolithotomy(PCNL) as surgical management strategies for solitary kidney calculi. Methods: Our team searched the PubMed, Cochrane and Web of Science databases up to February 28, 2019, for relevant published studies. After data extraction and quality assessment, Review Manager 5.3.5.0 software was used to pool the data. Results: Four studies involving 314 patients were included in our meta-analysis. The pooled data showed that the stone-free rate(SFR) was higher in the PCNL group than in the RIRS group, and the difference was significant(OR:0.36, 95% CI: 0.20 to 0.67, P =0.001). No significant differences were found in minor complications or major complications between the RIRS and PCNL groups(P > 0.05, OR:0.79, 95% CI: 0.46 to 1.35;p > 0.05, OR:2.96, 95% CI: 0.67 to 12.96, respectively). Conclusions: Neither the minor nor the major complications of RIRS and PCNL showed any statistical differences. Additionally, PCNL provided a higher SFR than RIRS. There exists enormous heterogeneity in mean operation time. Overall, this meta-analysis may help urologists make decisions regarding interventions for solitary kidney calculi management. Keywords: Solitary kidney, Calculi, Retrograde Intrarenal surgery, Percutaneous Nephrolithotomy, Meta-analysis

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.

Mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the treatment of 10–20 mm lower pole renal stones: a systematic review and meta-analysis

2019 ◽  
Vol 38 (10) ◽  
pp. 2621-2628 ◽  
Author(s):  
José D. Cabrera ◽  
Braulio O. Manzo ◽  
José E. Torres ◽  
Fabio C. Vicentini ◽  
Héctor M. Sánchez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Percutaneous Nephrolithotomy ◽  
Meta Analysis ◽  
Renal Stones ◽  
Lower Pole ◽  
Retrograde Intrarenal Surgery

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

2014 ◽  
Vol 93 (4) ◽  
pp. 417-424 ◽  
Author(s):  
Changjian Zheng ◽  
Bo Xiong ◽  
Hongzhi Wang ◽  
Jun Luo ◽  
Chenggou Zhang ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Meta Analysis ◽  
Renal Stones ◽  
Retrograde Intrarenal Surgery

Percutaneous-Based Management of Staghorn Calculi in Solitary Kidney: Combined Mini Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery

2014 ◽  
Vol 94 (1) ◽  
pp. 70-73 ◽  
Author(s):  
Wen Zhong ◽  
Zhijian Zhao ◽  
Liang Wang ◽  
Sunil Swami ◽  
Guohua Zeng
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Operation Time ◽  
Solitary Kidney ◽  
Retrograde Intrarenal Surgery ◽  
Staghorn Calculi ◽  
Combined Use ◽  
Stone Free Rate ◽  
Group 2 ◽  
Free Rate ◽  
Group 1

Introduction: Mini percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are well-established techniques with little morbidity. The combined use of standard PCNL and the mini-PCNL or the RIRS technique was evaluated and compared to investigate their own role in the management of staghorn calculi in solitary kidney. Materials and Methods: 23 patients received combined standard PCNL and mini-PCNL (group 1), and 22 patients received combined standard PCNL and RIRS (group 2). The treatment results and complications were evaluated and compared. Results: The mean operation time was 128.8 ± 9.1 min in group 1 and 109.8 ± 10.7 min in group 2 (p < 0.001). The decrease in hemoglobin level in group 1 was significantly higher than that in group 2 (3.5 ± 0.6 vs. 2.1 ± 0.5 g/dl, p < 0.001). The final stone-free rate was significantly higher (p = 0.038) in group 2 (90.9%) than in group 1 (65.2%). Conclusions: Combined standard PCNL and RIRS technique can extract the majority of staghorn calculi quickly by PCNL with EMS Lithoclast, and RIRS used simultaneously can reduce the need for multiple tracts and therefore reduce blood loss and potential morbidity related to multiple tracts, shorten the operation time and achieve a high stone-free rate.

scholarly journals Renal function evaluation after percutaneous nephrolithotomy in patients with solitary kidney

2021 ◽  
Vol 5 (2) ◽  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Creatinine Clearance ◽  
Percutaneous Nephrolithotomy ◽  
Operation Time ◽  
Renal Stones ◽  
Solitary Kidney ◽  
Early Postoperative Period ◽  
Function Evaluation ◽  
Time Duration

Objective: To evaluate renal function change after percutaneous nephrolithotomy in patients with solitary kidney. Methods: A prospective study conducted in the urology department at Rizgary Teaching Hospital for a period of 15 months from first of June 2018 until the end of August 2019. It included nine adult patients, all of them with solitary kidney and undergone percutaneous nephrolithotomy for management of renal calculi. Patients were considered to have a solitary kidney in case of congenital abnormality, contralateral nephrectomy, or solitary functioning kidney with contralateral atrophy (relative function < 10%). All patients were received prophylactic antibiotics (Ceftriaxone) at induction of anesthesia. All percutaneous nephrolithotomy procedures performed under general anesthesia in the prone position. Serum creatinine and creatinine clearance before the operation, at day one and day 21 postoperatively, operation time, duration of hospitalization, and postoperative complications recorded. Results: In this study, Means of serum creatinine at 1 day and 21 days postoperatively were significantly decreased compared to preoperative s. creatinine level Mean of creatinine clearance significantly increased after 21 days postoperatively compared to preoperative test, while no significant change in creatinine clearance after one day postoperatively. Conclusion: Generally, percutaneous nephrolithotomy considered as a safe and effective option for treatment of renal stones in solitary kidney patients considering the overall rate of complications and minimal morbidity. Moreover, significant renal function improvement anticipated in the early postoperative period.

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