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Review
. 2022 Mar 28;12(4):532.
doi: 10.3390/jpm12040532.

Endoscopic Combined Intrarenal Surgery Versus Percutaneous Nephrolithotomy for Complex Renal Stones: A Systematic Review and Meta-Analysis

Yung-Hao Liu  1 , Hong-Jie Jhou  2 , Meng-Han Chou  1 , Sheng-Tang Wu  1 , Tai-Lung Cha  1 , Dah-Shyong Yu  1 , Guang-Huan Sun  1 , Po-Huang Chen  3 , En Meng  1
Affiliations
Review

Endoscopic Combined Intrarenal Surgery Versus Percutaneous Nephrolithotomy for Complex Renal Stones: A Systematic Review and Meta-Analysis

Yung-Hao Liu et al. J Pers Med. .

Abstract

Background: Endoscopic combined intrarenal surgery (ECIRS) adds ureteroscopic vision to percutaneous nephrolithotomy (PCNL), which can be helpful when dealing with complex renal stones. Yet, there is still no consensus on the superiority of ECIRS. We aimed to critically analyze the available evidence of studies comparing efficacy, safety, bleeding risk, and efficiency of ECIRS and PCNL.

Methods: We searched for studies comparing efficacy (initial and final stone-free rate), safety (postoperative fever, overall and severe complications), efficiency (operative time and hospital stay) and bleeding risk between ECIRS and PCNL. Meta-analysis was performed.

Results: Seven studies (919 patients) were identified. ECIRS provided a significantly higher initial stone-free rate, higher final stone-free rate, lower overall complications, lower severe complications, and lower rate of requiring blood transfusion. There was no difference between the two groups in terms of postoperative fever, hemoglobin drop, operative time, and hospital stay. In the subgroup analysis, both minimally invasive and conventional ECIRS were associated with a higher stone-free rate and lower complication outcomes.

Conclusions: When treating complex renal stones, ECIRS has a better stone-free rate, fewer complications, and requires fewer blood transfusions compared with PCNL. Subgroups either with minimally invasive or conventional intervention showed a consistent trend.

Keywords: complex renal stones; efficiency; endoscopic combined intrarenal surgery; percutaneous nephrolithotomy; safety; stone-free rates.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure A1
Figure A1
Subgroup analysis of outcome regarding initial stone free rate. (Mini: [17,18,19,22,23]; Conventional: [20,21]).
Figure A2
Figure A2
Subgroup analysis of outcome regarding final stone free rate. (Mini: [17,19,22,23]; Conventional: [20]).
Figure A3
Figure A3
Subgroup analysis of outcome regarding overall complications. (Mini: [17,18,19,22,23]; Conventional: [20,21]).
Figure A4
Figure A4
Subgroup analysis of outcome regarding severe complications. (Mini: [17,18,19,22,23]; Conventional: [21]).
Figure A5
Figure A5
Subgroup analysis of outcome regarding post-operative fever. (Mini: [17,18,19,22,23]).
Figure A6
Figure A6
Subgroup analysis of outcome regarding hemoglobin drop. (Mini: [18,19,22,23]; Conventional: [21]).
Figure A7
Figure A7
Subgroup analysis of outcome regarding required blood transfusion. (Mini: [17,18,19,22,23]; Conventional: [21]).
Figure A8
Figure A8
Subgroup analysis of outcome regarding operative time (Mini: [17,18,19,22,23]; Conventional: [21]).
Figure A9
Figure A9
Subgroup analysis of outcome regarding hospital stay. (Mini: [17,18,19,22,23]; Conventional: [20]).
Figure A10
Figure A10
Subgroup analysis of outcome regarding initial stone free rate. (RCS: [18,19,20,21,22,23]; RCT: [17]).
Figure A11
Figure A11
Subgroup analysis of outcome regarding final stone free rate. (RCS: [18,19,20,21,22,23]; RCT: [17]).
Figure A12
Figure A12
Subgroup analysis of outcome regarding overall complications. (RCS: [18,19,20,21,22,23]; RCT: [17]).
Figure A13
Figure A13
Subgroup analysis of outcome regarding severe complications. (RCS: [18,19,20,21,22,23]; RCT: [17]).
Figure A14
Figure A14
Subgroup analysis of outcome regarding post-operative fever. (RCS: [18,19,20,21,22,23]; RCT: [17]).
Figure A15
Figure A15
Subgroup analysis of outcome regarding hemoglobin drop. (RCS: [18,19,21,22,23]).
Figure A16
Figure A16
Subgroup analysis of outcome regarding required blood transfusion. (RCS: [18,19,21,22,23]; RCT: [17]).
Figure A17
Figure A17
Subgroup analysis of outcome regarding operative time. (RCS: [18,19,21,22,23]; RCT: [17]).
Figure A18
Figure A18
Subgroup analysis of outcome regarding hospital stay. (RCS: [18,19,21,22,23]; RCT: [17]).
Figure A19
Figure A19
Sensitivity analysis of outcome regarding initial stone free rate. ([17,18,19,20,22,23]).
Figure A20
Figure A20
Sensitivity analysis of outcome regarding final stone free rate. ([17,19,20,22,23]).
Figure A21
Figure A21
Sensitivity analysis of outcome regarding overall complications. ([17,18,19,20,22,23]).
Figure A22
Figure A22
Sensitivity analysis of outcome regarding severe complications. ([17,18,19,22,23]).
Figure A23
Figure A23
Sensitivity analysis of outcome regarding post-operative fever. ([17,18,19,22,23]).
Figure A24
Figure A24
Sensitivity analysis of outcome regarding hemoglobin drop. ([18,19,22,23]).
Figure A25
Figure A25
Sensitivity analysis of outcome regarding required blood transfusion. ([17,18,19,22,23]).
Figure A26
Figure A26
Sensitivity analysis of outcome regarding operative time. ([17,18,19,22,23]).
Figure A27
Figure A27
Sensitivity analysis of outcome regarding hospital stay. ([17,18,19,20,22,23]).
Figure A28
Figure A28
Sensitivity analysis of outcome regarding initial stone free rate. ([17,18,19,22]).
Figure A29
Figure A29
Sensitivity analysis of outcome regarding final stone free rate. ([17,19,22]).
Figure A30
Figure A30
Sensitivity analysis of outcome regarding overall complications. ([17,18,19,22]).
Figure A31
Figure A31
Sensitivity analysis of outcome regarding severe complications. ([17,18,19,22]).
Figure A32
Figure A32
Sensitivity analysis of outcome regarding post-operative fever. ([17,18,19,22]).
Figure A33
Figure A33
Sensitivity analysis of outcome regarding hemoglobin drop. ([18,19,22]).
Figure A34
Figure A34
Sensitivity analysis of outcome regarding required blood transfusion. ([17,18,19,22]).
Figure A35
Figure A35
Sensitivity analysis of outcome regarding operative time. ([17,18,19,22]).
Figure A36
Figure A36
Sensitivity analysis of outcome regarding hospital stay. ([17,18,19,22]).
Figure A37
Figure A37
Comparison-adjusted funnel plot in outcome for initial stone free rate.
Figure A38
Figure A38
Comparison-adjusted funnel plot in outcome for final stone free rate.
Figure A39
Figure A39
Comparison-adjusted funnel plot in outcome for overall complications.
Figure A40
Figure A40
Comparison-adjusted funnel plot in outcome for severe complications.
Figure A41
Figure A41
Comparison-adjusted funnel plot in outcome for post-operative fever.
Figure A42
Figure A42
Comparison-adjusted funnel plot in outcome for hemoglobin drop.
Figure A43
Figure A43
Comparison-adjusted funnel plot in outcome for required blood transfusion.
Figure A44
Figure A44
Comparison-adjusted funnel plot in outcome for operative time.
Figure A45
Figure A45
Comparison-adjusted funnel plot in outcome for hospital stay.
Figure A46
Figure A46
Trial sequential analysis of outcome regarding initial stone free rate.
Figure A47
Figure A47
Trial sequential analysis of outcome regarding final stone free rate.
Figure A48
Figure A48
Trial sequential analysis of outcome regarding overall complications.
Figure A49
Figure A49
Trial sequential analysis of outcome regarding severe complications.
Figure A50
Figure A50
Trial sequential analysis of outcome regarding post-operative fever.
Figure A51
Figure A51
Comparison-adjusted funnel plot in outcome for hemoglobin drop.
Figure A52
Figure A52
Trial sequential analysis of outcome regarding required blood transfusion.
Figure A53
Figure A53
Comparison-adjusted funnel plot in outcome for operative time.
Figure A54
Figure A54
Comparison-adjusted funnel plot in outcome for hospital stay.
Figure 1
Figure 1
PRISMA flow diagram. mECIRS: mini-endoscopic combined intrarenal surgery, cECIRS: conventional endoscopic combined intrarenal surgery, PCNL: percutaneous nephrolithotomy.
Figure 2
Figure 2
Meta-analysis of efficacy outcomes, including (A) initial stone free rate [17,18,19,20,21,22,23] and (B) final stone free rate [17,19,20,22,23] between ECIRS and PCNL groups.
Figure 3
Figure 3
Meta-analysis of safety outcomes, including (A) overall complications [17,18,19,20,21,22,23], (B) severe complications [17,18,19,21,22,23], and (C) postoperative fever [17,18,19,22,23] between ECIRS and PCNL groups.
Figure 4
Figure 4
Meta-analysis of bleeding risks, including (A) hemoglobin drop [18,19,21,23] and (B) required blood transfusion [17,19,21,23] between ECIRS and PCNL groups.
Figure 5
Figure 5
Meta-analysis of efficiency outcomes, including (A) operative time [17,18,19,21,22,23] and (B) hospital stay [17,18,19,20,22,23] between ECIRS and PCNL groups.
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