Comparison between retrograde intrarenal surgery and percutaneous nephrolithotripsy in the management of renal stones: A meta-analysis

Abstract

Percutaneous nephrolithotripsy (PCNL) is recommended as the first-line treatment for the management of kidney stones that are ≥2 cm in diameter. Retrograde intrarenal surgery (RIRS) has become increasingly preferred due to its high level of safety and repeatability, particularly in small stones. However, whether PCNL has superior efficacy and lower complication rates when compared with RIRS remains controversial. Therefore, the present meta-analysis was conducted to compare the clinical outcomes of patients treated with PCNL and RIRS as therapy for renal stones. Clinical trials published in PubMed, Web of Science, Excerpta Medica dataBASE (EMBASE), and the Chinese Biomedical Database (CBM) were systematically reviewed to evaluate the efficacy and safety profiles of patients with renal stones who were treated with PCNL or RIRS. Main outcomes measures included stone-free rate, operative time, hospital stay, and complication rate. Results were expressed as risk ratio (RR), or weighted mean difference (WMD) with 95% confidence intervals (CIs). Pooled estimates were calculated using a fixed-effects or random-effects model according to the heterogeneity among the studies. In total, 17 studies [4 randomized controlled trials (RCTs) and 13 cohort studies] involving 1,717 patients met the inclusion criteria, and were included in this meta-analysis. Pooled results showed that PCNL exhibited a significantly higher stone-free rate (RR=0.90, 95% CI: 0.86 to 0.95; P<0.001) but was associated with a longer hospital stay, when compared with RIRS (WMD=-2.72, 95% CI: -3.9 to -1.54; P<0.001). Operative time (WMD=7.86, 95% CI: -0.89 to 16.61; P=0.078) and complication rate (RR=0.71, 95% CI: 0.48 to 1.05; P=0.083) did not significantly differ between the groups. Subgroup analysis revealed that PCNL had a shorter operation time than RIRS in patients with stone sizes ≥2 cm (WMD=12.88, 95% CI: 4.77 to 20.99; P=0.002), and PCNL had a similar stone-free rate as RIRS when the estimates were pooled from RCTs (RR=0.88, 95% CI: 0.76 to 1.01; P=0.078). Compared with PCNL, RIRS had a significantly lower stone-free rate, shorter hospital stay, but a similar operation time and complication rate. Therefore, we propose that RIRS may be an alternative therapy to PCNL, with acceptable efficacy and complication rates for renal stones. Further large-scale, well-conducted RCTs are required to verify our findings.

Keywords: meta-analysis; percutaneous nephrolithotripsy; renal stones; retrograde intrarenal surgery.

Figure 1.

Eligibility of studies for inclusion in the present meta-analysis.

Figure 2.

Comparison of percutaneous nephrolithotripsy or retrograde intrarenal surgery for patients with renal stones in terms of stone-free rate. RR, relative risk; CI, confidence interval.

Figure 3.

Comparison of percutaneous nephrolithotripsy or retrograde intrarenal surgery on stone-free rate in the subgroup analysis according to stone size. RR, relative risk; CI, confidence interval.

Figure 4.

Comparison of percutaneous nephrolithotripsy or retrograde intrarenal surgery for patients with renal stones in terms of hospital stay. WMD, weighted mean difference; CI, confidence interval.

Figure 5.

Comparison of percutaneous nephrolithotripsy or retrograde intrarenal surgery on hospital stay in the subgroup analysis according to study design. WMD, weighted mean difference; CI, confidence interval.

Figure 6.

Comparison of percutaneous nephrolithotripsy or retrograde intrarenal surgery for patients with renal stones in terms of operation time. WMD, weighted mean difference; CI, confidence interval.

Figure 7.

Comparison of percutaneous nephrolithotripsy or retrograde intrarenal surgery on operation time in the subgroup analysis according to study design. WMD, weighted mean difference; CI, confidence interval.

Figure 8.

Comparison of percutaneous nephrolithotripsy or retrograde intrarenal surgery for patients with renal stones in terms of complication rate. RR, relative risk; CI, confidence interval.