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

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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Outcome and safety of upper pole versus non-upper pole single puncture PCNL for staghorn stones: a systematic review and meta-analysis

F1000Research ◽

10.12688/f1000research.17806.1 ◽

2019 ◽

Vol 8 ◽

pp. 537

Author(s):

Steven Gunawan ◽

Ponco Birowo ◽

Nur Rasyid ◽

Widi Atmoko

Keyword(s):

Meta Analysis ◽

Direct Access ◽

Risk Of Bleeding ◽

Stone Free Rate ◽

Significant Difference ◽

Complications Rate ◽

Staghorn Stone ◽

Review Manager ◽

Free Rate ◽

Staghorn Stones

Background: Staghorn stones are mostly treated by percutaneous nephrolithotomy (PCNL), either with an upper-pole (UP) or non-upper (lower- or middle-) pole (NP) approach. NP access has a lower risk of bleeding and thoracic complications but may not be sufficient for complete stone clearance. UP access is advocated as the preferred approach, because of direct access to the collecting system. However, it is associated with a higher complications rate, including pneumothorax and hydrothorax, and a higher risk of bleeding. This meta-analysis aimed to describe the outcomes and safety of PCNL for staghorn stones using UP and NP approaches. Methods: A systematic literature review was conducted using several databases such as: PubMed; EBSCO; Science Direct; Cochrane and Google Scholar. Data from all selected articles were extracted by two independent reviewers. Relevant parameters explored using Review Manager V5.3. Results: Five comparative studies of staghorn stones involving 384 renal units were analyzed; 176 cases used the UP approach and 208 the NP approach. There was no significant difference in stone-free rate between these approaches, with 74.4% undergoing the UP approach and 71.1% the NP approach considered stone-free (OR: 1.55; 95% CI: 0.92-2.63; P=0.10). The rate of thoracic complications (hydrothorax and pneumothorax) did not differ significantly (OR: 3.14; 95% CI: 0.63-15.62; P=0.16). However, we noted that 5 of 176 patients that underwent the UP approach experienced thoracic complications. The incidence of post-procedural fever and sepsis is similar (OR: 1.18; 95% CI: 0.52-2.64; P=0.69). Neither post-procedural urine leakage (OR: 2.03; 95% CI: 0.70-5.85; P=0.19) nor requirement of blood transfusions (OR: 0.49; 95% CI: 0.14-1.76; P=0.27) differed significantly. Conclusion: PCNL with UP access for staghorn stone has a similar stone-free rate to the NP approach. Thoracic complication rate which was believed to be higher in the UP group is also deemed similar with NP access.

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

Canadian Urological Association Journal ◽

10.5489/cuaj.1994 ◽

2014 ◽

Vol 8 (11-12) ◽

pp. 906 ◽

Cited By ~ 4

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.

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Percutaneous nephrolithotomy versus open surgery for surgical treatment of patients with staghorn stones: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0206810 ◽

2019 ◽

Vol 14 (1) ◽

pp. e0206810 ◽

Cited By ~ 1

Author(s):

Yiwen Chen ◽

Jianhua Feng ◽

Haifeng Duan ◽

Youwei Yue ◽

Chaofeng Zhang ◽

...

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Percutaneous Nephrolithotomy ◽

Open Surgery ◽

Meta Analysis ◽

Staghorn Stones

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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

10.21203/rs.3.rs-16120/v1 ◽

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.

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

Journal of International Medical Research ◽

10.1177/0300060520983136 ◽

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.

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

10.21203/rs.3.rs-840809/v1 ◽

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.

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COMPARISON OF STONE FREE RATE OF STAGHORN STONE, RENAL PELVIC STONE, AND INFERIOR CALYX STONE FOLLOWING PCNL

Indonesian Journal of Urology ◽

10.32421/juri.v23i1.207 ◽

2016 ◽

Vol 23 (1) ◽

Author(s):

Pande Made Wisnu Tirtayasa ◽

Ponco Birowo ◽

Nur Rasyid

Keyword(s):

General Hospital ◽

Kidney Stones ◽

Medical Records ◽

Incomplete Data ◽

Inclusion Criteria ◽

Stone Free Rate ◽

Staghorn Stone ◽

Free Rate ◽

Free Status ◽

Staghorn Stones

Objective: To compare the stone free rates on patients with staghorn, renal pelvic, and inferior calyx stones with stone burden < 20 mm, 21-30 mm, and > 30 mm following percutaneous nephrolithotomy (PCNL) in Cipto Mangunkusumo General Hospital Jakarta. Material & methods: The data were collected retrospectively from PCNL medical records in Cipto Mangunkusumo General Hospital Jakarta between January 2000 and March 2011. Six hundred and twenty-three patients with 651 kidney stones underwent PCNL. The inclusion criteria were staghorn stones, renal pelvic stone, and inferior calyx stone. All cases outside these three criteria and incomplete data were excluded. Stone free status was defined as no residual fragment on radiography or ultrasonography. Results: As many as 364 kidney stones from 344 patients were included, with 47.8% cases of staghorn stones, 31.9% cases of renal pelvic stones, and 20.3% cases of inferior calyx stones. Overall, 273 (75%) cases were defined as stone free. In group < 20 mm, 4 staghorn stones (100%), 18 renal pelvic stones (81.8%), and 34 inferior calyx stones (94.4%) were cleared (p = 0.811). In group 21-30 mm, 20 staghorn stones (95.2%), 52 renal pelvic stones (91.2%), and 26 inferior calyx stones (92.9%) were cleared (p = 1.000). In group > 30 mm, 83 staghorn stones (55.7%), 28 renal pelvic stones (75.7%), and 8 inferior calyx stones (80%) were cleared (p = 0.037). Conclusion: PCNL is an important tool for treating various kinds and sizes of kidney stones with high stone free rate.

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

Urologia Internationalis ◽

10.1159/000369216 ◽

2015 ◽

Vol 95 (1) ◽

pp. 15-25 ◽

Cited By ~ 10

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.

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