scholarly journals Micropercutaneous Versus Minipercutaneous for the Management of Moderately Sized Kidney Stones: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Xiaoshuai Gao ◽  
Liang Zhou ◽  
Wei Wang ◽  
Xingpeng Di ◽  
Kaiwen Xiao ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Renal Colic ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Operation Time ◽  
Renal Stones ◽  
Stent Insertion ◽  
Continuous Variables ◽  
Stay Time ◽  
Hemoglobin Drop

Abstract Background: To assess the efficacy and safety of mini-percutaneous nephrolithotomy (Miniperc) and micropercutaneous nephrolithotomy (Microperc) for moderately sized renal stones. Methods: Literature search of PubMed, Web of Science, and Embase was performed before January 2020. We used odds ratios (OR) and weighted mean difference (WMD) for dichotomous variables and continuous variables, respectively. Results were pooled by Review Manager version 5.3 software. Results: A total of 4 studies involving 172 Microperc and 162 Miniperc cases were included. The overall SFR of Microperc was 86.05% (148/172), while the SFR of the Miniperc was 87.65% (142/162). Microperc was associated with lower hemoglobin drop (WMD: -0.98; P = 0.03), higher renal colic requiring D-J stent insertion (OR: 3.49; P=0.01). No significant differences exist between Microperc and Miniperc with respect to stone-free rate (SFR) (OR: 0.90; P=0.75), urinary tract infection (OR: 0.38; P=0.18), operative time (WMD: 14.73; P = 0.54) and hospital stay time (WMD: -1.04; P=0.07). Conclusions: Our meta-analysis demonstrated that Microperc could obtain comparable SFR with Miniperc. Microperc was associated with lower hemoglobin drop, but Miniperc was associated with lower renal colic rates. In addition, the operation time and hospital stay time for these two procedures were similar.

scholarly journals Comparison of Micro-Percutaneous and Mini-Percutaneous Nephrolithotomy in the Treatment of Renal Stones: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiaoshuai Gao ◽  
Wei Wang ◽  
Liao Peng ◽  
Xingpeng Di ◽  
Kaiwen Xiao ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Renal Colic ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Operation Time ◽  
Renal Stones ◽  
Stent Insertion ◽  
Stay Time ◽  
Hemoglobin Drop

Background: To assess the efficacy and safety of micro-percutaneous nephrolithotomy (Microperc) and mini-percutaneous nephrolithotomy (Miniperc) in the treatment of moderately sized renal stones.Methods: Literature search of PubMed, Web of Science, and Embase was performed prior to January 2021. We used odds ratios (OR) and weighted mean difference (WMD) for dichotomous variables and continuous variables, respectively. Results were pooled using Review Manager version 5.3 software.Results: A total of six studies involving 291 Microperc and 328 Miniperc cases was included. The overall stone-free rate (SFR) of Microperc was 87.29% (254/291), while the SFR of Miniperc was 86.59% (284/328). Microperc was associated with lower hemoglobin drop (WMD: −0.98; P = 0.03) and higher renal colic requiring D-J stent insertion (OR: 3.49; P = 0.01). No significant differences existed between Microperc and Miniperc with respect to SFR (OR: 1.10; P = 0.69), urinary tract infection (OR: 0.38; P = 0.18), operative time (WMD: −5.76; P = 0.62), and hospital stay time (WMD: −1.04; P = 0.07).Conclusions: Our meta-analysis demonstrated that Microperc could produce an SFR that was comparable with that of Miniperc. Microperc was associated with lower hemoglobin drop, while Miniperc was associated with lower renal colic rates. In addition, the operation time and hospital stay time for both these procedures were similar.

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 Laparoscopic versus open major liver resection for hepatocellular carcinoma: systematic review and meta-analysis of comparative cohort studies

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Zi-Yu Wang ◽  
Qing-Lian Chen ◽  
Ling-Ling Sun ◽  
Shu-Ping He ◽  
Xiao-Fen Luo ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Blood Loss ◽  
Hospital Stay ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Operation Time ◽  
Cochrane Library ◽  
Random Effects Models

Abstract Background The application of laparoscopic liver resection (LLR) has expanded rapidly in recent decades. Although multiple authors have reported LLR shows improved safety and efficacy in treating hepatocellular carcinoma (HCC) compared with open liver resection (OLR), laparoscopic (LMLR) and open (OMLR) major liver resections for HCC treatment remain inadequately evaluated. This work aimed to test the hypothesis that LMLR is safer and more effective than OMLR for HCC. Methods Comparative cohort and registry studies on LMLR and OMLR, searched in PubMed, the Science Citation Index, EMBASE, and the Cochrane Library, and published before March 31, 2018, were collected systematically and meta-analyzed. Fixed- and random-effects models were employed for generating pooled estimates. Heterogeneity was assessed by the Q-statistic. Results Nine studies (1173 patients) were included. Although the pooled data showed operation time was markedly increased for LMLR in comparison with OMLR (weighted mean difference [WMD] 74.1, 95% CI 35.1 to 113.1, P = 0.0002), blood loss was reduced (WMD = − 107.4, 95% CI − 179.0 to − 35.7, P = 0.003), postoperative morbidity was lower (odds ratio [OR] 0.47, 95% CI 0.35 to 0.63, P <  0.0001), and hospital stay was shorter (WMD = − 3.27, 95% CI − 4.72 to − 1.81, P <  0.0001) in the LMLR group. Although 1-year disease-free survival (DFS) was increased in patients administered LMLR (OR = 1.55, 95% CI 1.04 to 2.31, P = 0.03), other 1-, 3-, and 5-year survival outcomes (overall survival [OS] and/or DFS) were comparable in both groups. Conclusions Compared with OMLR, LMLR has short-term clinical advantages, including reduced blood loss, lower postsurgical morbidity, and shorter hospital stay in HCC, despite its longer operative time. Long-term oncological outcomes were comparable in both groups.

scholarly journals Fatty Liver Disease and Non-Alcoholic Fatty Liver Disease Worsen the Outcome in Acute Pancreatitis: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 9 (9) ◽  
pp. 2698
Author(s):  
Szilárd Váncsa ◽  
Dávid Németh ◽  
Péter Hegyi ◽  
Zsolt Szakács ◽  
Péter Jeno Hegyi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Pancreatitis ◽  
Liver Disease ◽  
Fatty Liver ◽  
Hospital Stay ◽  
Fatty Liver Disease ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

The prevalence of fatty liver disease (FLD) and that of non-alcoholic fatty liver disease (NAFLD) share some risk factors known to exacerbate the course of acute pancreatitis (AP). This meta-analysis aimed to investigate whether FLD or NAFLD carry a higher risk of untoward outcomes in AP. In accordance with PRISMA guidelines, we performed a systematic search in seven medical databases for cohort studies that compared the outcomes of AP for the presence of FLD or NAFLD, and we calculated pooled odds ratio (OR) or weighted mean difference (WMD) with 95% confidence interval (CI). We included 13 articles in our meta-analysis. AP patients with FLD were more likely to die (5.09% vs 1.89%, OR = 3.56, CI = 1.75–7.22), develop severe AP (16.33% vs 7.87%, OR = 2.67, CI = 2.01–3.56), necrotizing pancreatitis (34.83% vs 15.75%, OR = 3.08, CI = 2.44–3.90) and had longer in-hospital stay (10.8 vs 9.2 days, WMD = 1.46, OR = 0.54–2.39). Patients with NAFLD were more likely to have severe AP and longer hospital stay. Both FLD and NAFLD proved to be independent risk factors of a more severe disease course (OR = 3.68, CI = 2.16–6.29 and OR = 3.39, CI = 1.52–7.56 for moderate/ severe vs. mild AP, respectively). FLD and NAFLD worsen the outcomes of AP, which suggests that incorporating FLD or NAFLD into prognostic scoring systems of AP outcomes might improve the prediction of severity and contribute to a more individualized patient care.

scholarly journals An Early Experience of Retrograde Intrarenal Surgery (RIRS) in National Institute of Kidney Diseases and Urology

2020 ◽  
Vol 23 (1) ◽  
pp. 3-10
Author(s):  
Md Nasir Uddin ◽  
Imtiaz Enayetullah ◽  
Kazi Zikrur Razzaque ◽  
Sharif Md Shahadat Ali Khan ◽  
Kazi Rafiqul Abedin
Keyword(s):  
Statistical Analysis ◽  
Blood Transfusion ◽  
Hospital Stay ◽  
Kidney Diseases ◽  
Operation Time ◽  
Renal Stones ◽  
Retrograde Intrarenal Surgery ◽  
Ureteral Access Sheath ◽  
Access Sheath ◽  
The Mean

Background: Advancements in the endoscopic armamentarium, retrograde intrarenal surgery has become a viable and attractive option for the treatment of renal stones because of its high stone-free rates (SFRs) and low morbidity. Objective: To describe our experience and outcome of RIRS for the treatment of renal stones and to assess its effectiveness and safety. Design, setting, and participants: A retrospective analysis of 60 patients who underwent RIRS for renal stones at our institute between January 2018 to December 2018 was performed. Surgical procedure: Flexible ureteroscopy and laser lithotripsy using a standardized technique with last-generation flexible ureteroscopes (Flex-Xc) using Holmium-YAG laser. Outcome measurements and statistical analysis: Clinical data were collected and intraoperative and postoperative outcomes were assessed (Ureteral access sheath placement, operation time, hospital stay, stone free rate, post-operative blood transfusion & fever, need for second session of RIRS. A descriptive statistical analysis was performed. Results and limitations: The mean overall stone size was 13±3 mm. Pre stenting done in all cases. Ureteral access sheath placement was possible in 54(90%) patients. At 1 month follow-up, the overall primary SFR was 86.67%(52 cases), the secondary SFR was 96.67%(58 cases).The mean operative time was 91.96±18.7 min. Mean hospital stay was 1.86±1.02 days. Complications were reported in 8 (13.33%) patients overall, with fever in 6 patients (10%), steinstrasse in 2(3.33%) patients need for second session RIRS in 6 patients (10%).No patient needed blood transfusion. The main limitation of the study is the retrospective nature. Conclusions: RIRS performed using a flexible ureterorenoscope marked the beginning of a new era in urology. It is safe and effective procedure and an alternative to extracorporeal shock wave lithotripsy (ESWL) and Percutaneous nephrolithotomy (PCNL) in the treatment of selected renal stones. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.3-10

scholarly journals Perioperative morbidity of different operative approaches in early cervical carcinoma: a systematic review and meta-analysis comparing minimally invasive versus open radical hysterectomy

2021 ◽  
Author(s):  
J. Kampers ◽  
E. Gerhardt ◽  
P. Sibbertsen ◽  
T. Flock ◽  
H. Hertel ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Radical Hysterectomy ◽  
Postoperative Morbidity ◽  
Meta Analysis ◽  
Operation Time ◽  
Mean Difference ◽  
Inclusion Criteria ◽  
Estimated Blood Loss

Abstract Purpose Radical hysterectomy and pelvic lymphadenectomy is the standard treatment for early cervical cancer. Studies have shown superior oncological outcome for open versus minimal invasive surgery, but peri- and postoperative complication rates were shown vice versa. This meta-analysis evaluates the peri- and postoperative morbidities and complications of robotic and laparoscopic radical hysterectomy compared to open surgery. Methods Embase and Ovid-Medline databases were systematically searched in June 2020 for studies comparing robotic, laparoscopic and open radical hysterectomy. There was no limitation in publication year. Inclusion criteria were set analogue to the LACC trial. Subgroup analyses were performed regarding the operative technique, the study design and the date of publication for the endpoints intra- and postoperative morbidity, estimated blood loss, hospital stay and operation time. Results 27 studies fulfilled the inclusion criteria. Five prospective, randomized-control trials were included. Meta-analysis showed no significant difference between robotic radical hysterectomy (RH) and laparoscopic hysterectomy (LH) concerning intra- and perioperative complications. Operation time was longer in both RH (mean difference 44.79 min [95% CI 38.16; 51.42]), and LH (mean difference 20.96 min; [95% CI − 1.30; 43.22]) than in open hysterectomy (AH) but did not lead to a rise of intra- and postoperative complications. Intraoperative morbidity was lower in LH than in AH (RR 0.90 [0.80; 1.02]) as well as in RH compared to AH (0.54 [0.33; 0.88]). Intraoperative morbidity showed no difference between LH and RH (RR 1.29 [0.23; 7.29]). Postoperative morbidity was not different in any approach. Estimated blood loss was lower in both LH (mean difference − 114.34 [− 122.97; − 105.71]) and RH (mean difference − 287.14 [− 392.99; − 181.28]) compared to AH, respectively. Duration of hospital stay was shorter for LH (mean difference − 3.06 [− 3.28; − 2.83]) and RH (mean difference − 3.77 [− 5.10; − 2.44]) compared to AH. Conclusion Minimally invasive radical hysterectomy appears to be associated with reduced intraoperative morbidity and blood loss and improved reconvalescence after surgery. Besides oncological and surgical factors these results should be considered when counseling patients for radical hysterectomy and underscore the need for new randomized trials.

Comparison of Clinical Efficacy and Complications Between Laparoscopic Versus Open Surgery for Low Rectal Cancer

2019 ◽  
Vol 22 (3) ◽  
pp. 179-186 ◽  
Author(s):  
Jian Dai ◽  
Zhou Yu
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Blood Loss ◽  
Hospital Stay ◽  
Complication Rate ◽  
Open Surgery ◽  
Operation Time ◽  
Lower Rectal Cancer ◽  
Surgery Group ◽  
Stay Time

Aim: To compare the surgical outcomes of laparoscopic surgery for lower rectal cancer with open surgery. Methods: The multiple databases including PubMed, Springer, EMBASE, EMBASE, OVID were adopted to search for the relevant studies, and full-text articles involving the comparison of unilateral and bilateral PVP surgery were reviewed. Review Manager 5.0 was adopted to estimate the effects of the results among the selected articles. Forest plots, sensitivity analysis and bias analysis for the articles included were also conducted. Results: Finally, 1186 patients were included in the 10 studies, which eventually satisfied the eligibility criteria, and laparoscopic and open surgery group were 646 and 540, respectively. The meta-analysis suggested that there was no significant difference of the operation time between laparoscopic and open surgery group, while the time to solid intake, hospital stay time, blood loss and complication rate of laparoscopic group are much less than those of open surgery. Conclusion: Although both these two punctures provide similar operation time, we encourage the use of the laparoscopic surgery as the preferred surgical technique for treatment of lower rectal cancer due to less time to solid intake, hospital stay time, blood loss and lower complication rate.

scholarly journals Procalcitonin guidance in patients with lower respiratory tract infections: a systematic review and meta-analysis

2018 ◽  
Vol 56 (8) ◽  
pp. 1200-1209 ◽  
Author(s):  
Juliane Hey ◽  
Philippe Thompson-Leduc ◽  
Noam Y. Kirson ◽  
Louise Zimmer ◽  
Dana Wilkins ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Antibiotic Use ◽  
Lower Respiratory Tract Infections ◽  
Weighted Mean ◽  
Tract Infections

Abstract Although effective for bacterial lower respiratory tract infections (LRTIs), antibiotic treatment is often incorrectly prescribed for non-bacterial LRTIs. Procalcitonin has emerged as a promising biomarker to diagnose bacterial infections and guide antibiotic treatment decisions. As part of a regulatory submission to the U.S. Food and Drug Administration, this systematic review and meta-analysis summarizes the effects of procalcitonin-guided antibiotic stewardship on antibiotic use and clinical outcomes in adult LRTI patients. PubMed and the Cochrane Database of Systematic Reviews were searched for English-language randomized controlled trials published between January 2004 and May 2016. Random and fixed effects meta-analyses were performed to study efficacy (initiation of antibiotics, antibiotic use) and safety (mortality, length of hospital stay). Eleven trials were retained, comprising 4090 patients. Procalcitonin-guided patients had lower odds of antibiotic initiation (odds ratio: 0.26; 95% confidence interval [CI]: 0.13–0.52) and shorter mean antibiotic use (weighted mean difference: −2.15 days; 95% CI: −3.30 to −0.99) compared to patients treated with standard care. Procalcitonin use had no adverse impact on mortality (relative risk: 0.94; 95% CI: 0.69–1.28) and length of hospital stay (weighted mean difference: −0.15 days; 95% CI: −0.60 to 0.30). Procalcitonin guidance reduces antibiotic initiation and use among adults with LRTIs with no apparent adverse impact on length of hospital stay or mortality.

scholarly journals Is routine ureteral stenting really necessary after retrograde intrarenal surgery?

2015 ◽  
Vol 87 (1) ◽  
pp. 72 ◽  
Author(s):  
Ekrem Ozyuvali ◽  
Berkan Resorlu ◽  
Ural Oguz ◽  
Yildiray Yildiz ◽  
Tolga Sahin ◽  
...  
Keyword(s):  
Renal Colic ◽  
Operation Time ◽  
Stent Insertion ◽  
Dimension Stone ◽  
Retrograde Intrarenal Surgery ◽  
Residual Stone ◽  
Double J Stent ◽  
Group 2 ◽  
Free Status ◽  
Group 1

Objectives: To investigate the situations in which ureteral double-J stent should be used after retrograde intrarenal surgery (RIRS). Patients and Methods: Patients with no ureteral double-J stent after RIRS constituted Group 1, and those with double- J stent after RIRS constituted Group 2. Patients’ age and gender, renal stone characteristics (location and dimension), stone-free status, VAS score 8 hours after surgery, post-procedural renal colic attacks, length of hospitalization, requirement for re-hospitalization, time to rehospitalization and secondary procedure requirements were analyzed. Results: RIRS was performed on 162 renal units. Double-J stent was used in 121 (74.6%) of these after RIRS, but not in the other 41 (25.4%). At radiological monitoring at the first month postoperatively after RIRS, complete stone-free status was determined in 122 (75.3%) renal units, while residual stone was present in 40 (24.6%). No significant differences were observed between the groups in terms of duration of fluoroscopy (p = 0.142), operation (p = 0.108) or hospitalization times (p = 0.798). VAS values determined routinely on the evening of surgery were significantly higher in Group 1 than in Group 2 (p = 0.025). Twenty-eight (17.2%) presentations were made to the emergency clinic due to renal colic within 1 month after surgery. Double-J catheter was present in 24 (85.7%) of these patients. Conclusions: Routine double-J stent insertion after RIRS is not essential since it increases costs, morbidity and operation time.

Microfracture versus Enhanced Microfracture Techniques in Knee Cartilage Restoration: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Hong-Jie Wen ◽  
Li-Bo Yuan ◽  
Hong-Bo Tan ◽  
Yong-Qing Xu
Keyword(s):  
Cartilage Repair ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Visual Analog Scale Score ◽  
International Knee Documentation Committee ◽  
Mean Difference ◽  
Cartilage Defects ◽  
Continuous Variables ◽  
Significant Difference ◽  
Registration Number

AbstractThis study aimed to compare the efficacy and safety of the microfracture (MFx) and microfracture augmented (MFx + ) techniques for the treatment of cartilage defects of the knee. The PubMed and EMBASE databases were searched from 1 January, 1950 to 1 May, 2019. RevMan5.3 was used to perform statistical analysis. Relative risk was calculated for binary variables, and weighted mean difference and standardized mean difference (SMD) were measured for continuous variables. The 95% confidence interval (CI) of each variable was assessed. Thirteen trials with 635 patients were included. There was a significant difference in the Lysholm's score (SMD = 0.26, 95% CI: 0.01–0.50, p = 0.04) and magnetic resonance observation of cartilage repair tissue score (SMD = 14.01, 95% CI: 8.01–20.02, p < 0.01) between the MFx and MFx+ groups. There was no significant difference in the Western Ontario and McMaster Universities Osteoarthritis Index score (SMD =  − 12.40, 95% CI: −27.50 to 32.71, p = 0.11), International Knee Documentation Committee score (SMD = 8.67, 95% CI: −0.92 to 18.27, p = 0.08), visual analog scale score (SMD =  − 0.20, 95% CI: −2.45 to 0.96, p = 0.57), Tegner's score (SMD = 0.26, 95% CI: −0.67 to 1.18, p = 0.59), modified Cincinnati's score (SMD =  − 4.58, 95% CI: −14.31 to 5.14, p = 0.36) and modified International Cartilage Repair Society pain score (SMD = 0.09, 95% CI: −0.37 to 0.55, p = 0.70) between the groups. Results of the pooled analyses of the MFx+ and MFx groups suggested that the MFx+ technique is slightly superior to the MFx technique for the treatment of articular cartilage defects of the knee. Further research is required and future studies should include assessments of the outcomes at long-term follow-ups. Trial registration number is PROSPERO CRD42019135803

Sign in / Sign up

Export Citation Format

Share Document