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. 2020 Dec 30;57(1):26.
doi: 10.3390/medicina57010026.

Effectiveness of Percutaneous Nephrolithotomy, Retrograde Intrarenal Surgery, and Extracorporeal Shock Wave Lithotripsy for Treatment of Renal Stones: A Systematic Review and Meta-Analysis

Chan Hee Kim  1 , Doo Yong Chung  2 , Koon Ho Rha  3 , Joo Yong Lee  3   4 , Seon Heui Lee  1
Affiliations

Effectiveness of Percutaneous Nephrolithotomy, Retrograde Intrarenal Surgery, and Extracorporeal Shock Wave Lithotripsy for Treatment of Renal Stones: A Systematic Review and Meta-Analysis

Chan Hee Kim et al. Medicina (Kaunas). .

Abstract

Background and objectives: To perform a updated systematic review and meta-analysis comparing effectiveness of percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stones (RS). Materials and Methods: A total of 37 studies were included in this systematic review and meta-analysis about effectiveness to treat RS. Endpoints were stone-free rates (SFR), incidence of auxiliary procedure, retreatment, and complications. We also conducted a sub-analysis of ≥2 cm stones. Results: First, PCNL had the highest SFR than others regardless of stone sizes and RIRS showed a higher SFR than ESWL in <2 cm stones. Second, auxiliary procedures were higher in ESWL than others, and it did not differ between PCNL and RIRS. Finally, in <2 cm stones, the retreatment rate of ESWL was higher than others. RIRS required significantly more retreatment procedures than PCNL in ≥2 cm stones. Complication was higher in PCNL than others, but there was no statistically significant difference in complications between RIRS and PCNL in ≥2 cm stones. For ≥2 cm stones, PCNL had the highest SFR, and auxiliary procedures and retreatment rates were significantly lower than others. Conclusions: We suggest that PCNL is a safe and effective treatment, especially for large RS.

Keywords: extracorporeal shock wave lithotripsy (SWL); percutaneous nephrolithotomy (PCNL); retrograde intrarenal surgery (RIRS); urolithiasis.

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Conflict of interest statement

The authors report no conflicts of interest in relation to this work.

Figures

Figure 1
Figure 1
Study flow chart. Thirty-seven studies were included in the qualitative analysis.
Figure 2
Figure 2
Funnel plot of the meta-analysis. (A) ESWL vs. PCNL; (B) ESWL vs. RIRS; (C) RIRS vs. PCNL. These funnel plots indicate the presence of little publication bias in all studies.
Figure 3
Figure 3
Meta-analysis of Stone-free rate: (a) ESWL versus PCNL; (b) ESWL versus RIRS; and (c) PCNL versus RIRS. Mantel-Haenszel (M-H), 95% confidence intervals (CI).
Figure 3
Figure 3
Meta-analysis of Stone-free rate: (a) ESWL versus PCNL; (b) ESWL versus RIRS; and (c) PCNL versus RIRS. Mantel-Haenszel (M-H), 95% confidence intervals (CI).
Figure 4
Figure 4
Meta-analysis (A). Stone-free rate (stone size ≤ 2 cm): (a) ESWL vs. PCNL; (b) ESWL vs. RIRS; (c) and PCNL vs. RIRS. Meta-analysis (B). Stone-free rate (stone size >2 cm): (a) ESWL vs. PCNL; and (b) PCNL vs. RIRS.
Figure 4
Figure 4
Meta-analysis (A). Stone-free rate (stone size ≤ 2 cm): (a) ESWL vs. PCNL; (b) ESWL vs. RIRS; (c) and PCNL vs. RIRS. Meta-analysis (B). Stone-free rate (stone size >2 cm): (a) ESWL vs. PCNL; and (b) PCNL vs. RIRS.
Figure 5
Figure 5
Meta-analysis of total complications: (a) ESWL vs. PCNL; (b) ESWL vs. RIRS; and (c) PCNL vs. RIRS.
Figure 5
Figure 5
Meta-analysis of total complications: (a) ESWL vs. PCNL; (b) ESWL vs. RIRS; and (c) PCNL vs. RIRS.
Figure 6
Figure 6
Meta-analysis (A). Total complications (stone size ≤ 2 cm): (a) ESWL vs. PCNL; (b) ESWL vs. RIRS; and (c) PCNL vs. RIRS. Meta-analysis (B). Total complications (stone size > 2 cm): (a) PCNL vs. RIRS.
Figure 6
Figure 6
Meta-analysis (A). Total complications (stone size ≤ 2 cm): (a) ESWL vs. PCNL; (b) ESWL vs. RIRS; and (c) PCNL vs. RIRS. Meta-analysis (B). Total complications (stone size > 2 cm): (a) PCNL vs. RIRS.
Figure 7
Figure 7
Meta-analysis of retreatment procedure: (a) ESWL vs. PCNL; (b) ESWL vs. RIRS; (c) PCNL vs. RIRS.
Figure 8
Figure 8
Meta-analysis (A). Retreatment procedure (stone size ≤ 2 cm): (a) ESWL vs. PCNL; (b) ESWL vs. RIRS; and (c) PCNL vs. RIRS. Meta-analysis (B). Retreatment procedure (stone size > 2 cm): (a) ESWL vs. PCNL; and (b) PCNL vs. RIRS.
Figure 9
Figure 9
Meta-analysis of auxiliary procedure: (a) ESWL vs. PCNL; (b) ESWL vs. RIRS; and (c) PCNL vs. RIRS.
Figure 10
Figure 10
Meta-analysis (A). Auxiliary procedure (stone size ≤ 2 cm): (a) ESWL vs. PCNL; (b) ESWL vs. RIRS; and (c) PCNL vs. RIRS. Meta-analysis (B). Auxiliary procedure (stone size > 2 cm): (a) ESWL vs. PCNL; and (b) PCNL vs. RIRS.
Figure 10
Figure 10
Meta-analysis (A). Auxiliary procedure (stone size ≤ 2 cm): (a) ESWL vs. PCNL; (b) ESWL vs. RIRS; and (c) PCNL vs. RIRS. Meta-analysis (B). Auxiliary procedure (stone size > 2 cm): (a) ESWL vs. PCNL; and (b) PCNL vs. RIRS.
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References

    1. Romero V., Akpinar H., Assimos D.G. Kidney stones: A global picture of prevalence, incidence, and associated risk factors. Rev. Urol. 2010;12:e86–e96. - PMC - PubMed
    1. Hesse A., Brandle E., Wilbert D., Kohrmann K.U., Alken P. Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs. 2000. Eur. Urol. 2003;44:709–713. doi: 10.1016/S0302-2838(03)00415-9. - DOI - PubMed
    1. Bas O., Bakirtas H., Sener N.C., Ozturk U., Tuygun C., Goktug H.N., Imamoglu M.A. Comparison of shock wave lithotripsy, flexible ureterorenoscopy and percutaneous nephrolithotripsy on moderate size renal pelvis stones. Urolithiasis. 2014;42:115–120. doi: 10.1007/s00240-013-0615-2. - DOI - PubMed
    1. Zhang W., Zhou T., Wu T., Gao X., Peng Y., Xu C., Chen Q., Song R., Sun Y. Retrograde Intrarenal Surgery Versus Percutaneous Nephrolithotomy Versus Extracorporeal Shockwave Lithotripsy for Treatment of Lower Pole Renal Stones: A Meta-Analysis and Systematic Review. J. Endourol. 2015;29:745–759. doi: 10.1089/end.2014.0799. - DOI - PubMed
    1. Jung H.D., Kim J.C., Ahn H.K., Kwon J.H., Han K., Han W.K., Kim M.D., Lee J.Y. Real-time simultaneous endoscopic combined intrarenal surgery with intermediate-supine position: Washout mechanism and transport technique. Investig. Clin. Urol. 2018;59:348–354. doi: 10.4111/icu.2018.59.5.348. - DOI - PMC - PubMed

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