Mini percutaneous nephrolithotomy versus standard percutaneous nephrolithotomy for the management of renal stones over 2 cm: a systematic review and meta-analysis of randomized controlled trials

Mykoniatis, Ioannis; Pietropaolo, Amelia; Pyrgidis, Nikolaos; Tishukov, Maksim; Anastasiadis, Anastasios; Jones, Patrick; Keller, Etienne Xavier; Talso, Michele; Tailly, Thomas; Kalidonis, Panagiotis

doi:10.23736/s2724-6051.22.04678-x

Cited by 9 publications

(4 citation statements)

References 43 publications

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“…Yuan et al [12] showed that PCNL was associated with a longer operative time and hospital stay but lower postoperative complication rate than transurethral urethroscopic lithotripsy. A meta-analysis [23] indicated that standard and mini PCNL was not signi cantly different in terms of postoperative pain, fever, complications, and duration of operation. Gauhar et al [24] concluded that tubeless PCNL (absence of ureteral stent and nephrostomy tube) had a shorter mean operative time than standard PCNL treatment, but there was no signi cant difference in postoperative pain scores and analgesic requirements.…”

Section: Discussionmentioning

confidence: 98%

Clinical Prediction Model for Severe Pain After Percutaneous Nephrolithotomy and Analysis of Associated Factors ：A Retrospective Study

Wei

et al. 2022

Preprint

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Objectives: This study aimed to develop severe pain prediction models for patients after percutaneous nephrolithotomy (PCNL), to identify and intervene the risk factors causing pain in a timely manner so as to improve patient satisfaction after surgery. Methods: The clinical data of 331 PCNL patients were retrospectively analyzed. Data of 265 patients (80%) were randomly selected as the training cohort and those of 66 (20%) patients were selected as the validation cohort. We choosed clinical data through the stepwise Akaike information criterion and best subset selection to build severe pain prediction models by the training data set. The validity of the model was verified and analyzed using the test data set. Results: The first clinical model was developed using the American Society of Anesthesiologists (ASA) classification, number of kidney stones, history of hydronephrosis, duration of surgery, and presence of stone remnants after surgery. This model had an area under the curve (AUC) of 0.8682 (95% confidence interval [CI], 0.8205–0.9160), threshold of 0.4771, sensitivity of 97.25%, specificity of 63.86%, and negative predictive value (NPV) of 91.38%. The second model was developed using the mentioned above six clinical features and size of kidney stones. This model showed a stronger discriminatory power (P=0.208), with an AUC of 0.8710 (95% CI, 0.8242–0.9187), threshold of 0.4813, sensitivity of 97.25%, specificity of 83.86%, and NPV of 91.38%. In the subsequent validation cohort (N = 66), the AUC (95% CI) was 0.9093 (0.8378–0.9808) for the first clinical model and 0.9098 (0.8373–0.9823) for the second clinical models. Conclusion: We developed two prediction models for postoperative pain severity in PCNL patients, which were validated internally. Trial registration: This is a retrospective study that does not include sensitive patient data, but only data provided by professionals from selected centres about their daily clinical practice. Therefore, our ethics Committee did not consider it necessary to register the study.

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Section: Discussionmentioning

confidence: 98%

Clinical Prediction Model for Severe Pain After Percutaneous Nephrolithotomy and Analysis of Associated Factors ：A Retrospective Study

Wei

et al. 2022

Preprint

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“…As well as the steeper learning curve, standard (maxi) PCNL is associated with a higher rate of serious complications compared to RIRS, the most noteworthy being bleeding. 13 However, miniaturization of PCNL equipment offers an additional intervention choice that is now available and can be associated with an improved safety profile compared to standard PCNL. A recent study comparing super mini PCNL and RIRS in children with stone burdens of 1–2 cm found the former to yield superior SFRs as well as a lower complication rate.…”

Section: Discussionmentioning

confidence: 99%

“…This study lacks the ability to comment on laser settings. The importance of this is increasingly being recognized alongside the need for operator awareness regarding of intra‐renal pressure and temperature 13,18,19 . This applies to RIRS in children as well.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…The importance of this is increasingly being recognized alongside the need for operator awareness regarding of intra‐renal pressure and temperature. 13 , 18 , 19 This applies to RIRS in children as well. Future studies evaluating the use of suction devices during RIRS will be of interest in improving SFR and minimizing need for secondary interventions.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Outcomes and considerations for retrograde intrarenal surgery (RIRS) in the setting of multiple and large renal stones (>15 mm) in children: Findings from multicentre and real‐world setting

Juliebø‐Jones,

Gauhar,

Lim

et al. 2024

BJUI Compass

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PurposeThe aim of this study is to evaluate the outcomes of retrograde intra renal surgery (RIRS) in the setting of large or multiple stones in children (<18 years).Materials and MethodsRetrospective analysis was performed of paediatric RIRS cases at nine centres worldwide over a 6‐year period. Patients were divided into two groups: Group 1 had a single stone <15 mm. Group 2 had either multiple stones, maximum stone diameter of >15 mm, or both. Outcomes included stone free rate (SFR) and complications within 30 days.ResultsIn total, 344 patients were included with 197 and 147 in Groups 1 and 2, respectively. Ureteric access sheaths were more frequently used in Group 2 (39.5% vs. 56.8%, p = 0.021). The operation time was significantly longer in Group 2 (p < 0.001). SFR after a single procedure was 84.7% in Group 1 and 63.7% in Group 2. Overall complication rates in Groups 1 and 2 were 7.6% and 33.3%, respectively. The most frequently reported complication in both groups was post‐operative fever (4.4% vs. 14%, p = 0.004). The rate of Clavien I/II complications in groups 1 and 2 was 6% and 25.1%, respectively (p < 0.05). The rate of Clavien ≥ III complications in groups 1 and 2 was 1.6% and 8.1%, respectively (p < 0.05). On multivariate analysis, total operation time, stone size and multiplicity were significant predictors of residual fragments.ConclusionsRIRS can be performed in paediatric cases with large and multiple stone burdens, but the complication rate is significantly higher when compared to smaller stones.

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Efficacy and safety of various endosurgical procedures for management of large renal stone: a systemic review and network meta-analysis of randomised control trials

Awedew,

Alemu,

Yalew

2023

Urolithiasis

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Mini percutaneous nephrolithotomy versus standard percutaneous nephrolithotomy for the management of renal stones over 2 cm: a systematic review and meta-analysis of randomized controlled trials

Cited by 9 publications

References 43 publications

Clinical Prediction Model for Severe Pain After Percutaneous Nephrolithotomy and Analysis of Associated Factors ：A Retrospective Study

Clinical Prediction Model for Severe Pain After Percutaneous Nephrolithotomy and Analysis of Associated Factors ：A Retrospective Study

Outcomes and considerations for retrograde intrarenal surgery (RIRS) in the setting of multiple and large renal stones (>15 mm) in children: Findings from multicentre and real‐world setting

Efficacy and safety of various endosurgical procedures for management of large renal stone: a systemic review and network meta-analysis of randomised control trials

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