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Meta-Analysis
. 2017:2017:2035851.
doi: 10.1155/2017/2035851. Epub 2017 May 3.

Minimally Invasive Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery for Upper Urinary Stones: A Systematic Review and Meta-Analysis

Hongyang Jiang  1 , Zhe Yu  1 , Liping Chen  1 , Tao Wang  1 , Zhuo Liu  1 , Jihong Liu  1 , Shaogang Wang  1 , Zhangqun Ye  1
Affiliations
Meta-Analysis

Minimally Invasive Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery for Upper Urinary Stones: A Systematic Review and Meta-Analysis

Hongyang Jiang et al. Biomed Res Int. 2017.

Abstract

Minimally invasive percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are both alternatives for PCNL to treat renal calculi. This study is aimed at comparing the stone-free rate (SFR) and other surgery parameters of two approaches for treating upper urinary calculi. We performed this meta-analysis in September 2016 by searching studies about mini-PCNL and RIRS for treating upper urinary calculi in various databases, and RevMan v.5.3 was applied. Three randomized controlled trials and ten nonrandomized trials were included, involving a total of 1317 patients. Meta-analysis showed that mini-PCNL group led to a higher SFR [odds ratio: 1.96; 95% confidence interval: 1.46-2.64; P < 0.00001] but brought a larger postoperative decrease in hemoglobin levels compared with RIRS. RIRS provided a shorter hospital time. There was no significant difference in operation time. Higher postoperative complications were detected in the mini-PCNL, but the difference was not significant. Grade I and III complications did not vary between two procedures, but grade II complications were of lower incidence in RIRS group. In the light of these results, compared with RIRS, mini-PCNL provided significantly higher SFR and efficiency quotient for managing calculi; however, it resulted in higher incidence of postoperative complications, larger hemoglobin drops, and longer hospital stay.

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Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Forest plot and meta-analysis of stone-free rate in renal stone patients.
Figure 3
Figure 3
Forest plot and meta-analysis of location subgroup of stone-free rate.
Figure 4
Figure 4
Forest plot and meta-analysis of stone size subgroup of stone-free rate.
Figure 5
Figure 5
Forest plot and meta-analysis of outcomes in renal stone patients: (a) operative time; (b) hospital stay; (c) hemoglobin drop.
Figure 6
Figure 6
Forest plot and meta-analysis of total complications for two procedures.
Figure 7
Figure 7
Forest plot and meta-analyses of postoperative complications.
Figure 8
Figure 8
Funnel plot for the publication bias test of mini-PCNL versus RIRS.
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