Minimally invasive versus standard percutaneous nephrolithotomy: a meta-analysis

Abstract

The aim of the study was to objectively analyze the outcomes for minimally invasive percutaneous nephrolithotomy (MPCNL) vs standard percutaneous nephrolithotomy (PCNL) by systematic review and meta-analysis of published data. A systematic literature review was performed in November 2014 using the PUBMED, EMBASE and Cochrane Library databases to identify relevant studies. Only comparative studies investigating MPCNL vs PCNL were included. Effect sizes were estimated by pooled odds ratio (ORs) and mean differences (MDs). The analyzed outcomes were stone-free rate (SFR), blood loss, pain assessment, operative time, hospital stay and complications. We identified 8 trials with a total 749 patients. 353 patients were treated with MPCNL and 396 with PCNL. Meta-analysis of the data showed that there was no difference in SFR between MPCNL and PCNL (OR 1.06, 95% CI 0.71-1.58). Patients in the MPCNL group experienced less drop in hemoglobin (MD: -4.67 g/L, 95% CI -7.29 to -2.04), a lower incidence of blood transfusion (OR 0.18, 95% CI 0.06-0.54), less pain (visual analog score) (MD: -0.53, 95% CI -0.94 to -0.13) and shorter hospitalization (MD: -1.32 days, 95% CI -2.15 to -0.50). Operative time was longer in the MPCNL group (MD: 15.54 min, 95% CI 4.25-26.83). Postoperative fever and pyelocalyceal perforation did not differ between the groups (p = 0.38 and 0.44, respectively). Current evidence suggested that MPCNL was a safe and effective procedure with an SFR comparable to that of PCNL. MPCNL resulted in less bleeding, fewer transfusion, less pain and shorter hospitalization. Well-designed multicentric/international randomized, controlled trials are still needed.

The Urological Association of Asia clinical guideline for urinary stone disease

“…[179][180][181][182] Miniaturized PCNL can be considered when there are diverticular stones, and pediatric medium-sized stones as well (LE:4). 179,180,183 Miniaturized PCNL has shown comparable surgical outcomes to conventional PCNL in terms of SFRs with lower probability of complications; 184,185 however, it seems to have longer operative times and higher intrarenal pressure than conventional PCNL during surgery. 186,187 The surgical outcomes of miniaturized PCNL are promising, with good SFRs, shorter hospital stay and reduced risk of morbidity, such as bleeding, adjacent organ injury and so on (LE:1).…”

“…The summarized flow chart for treatment algorithm is shown in Figure 3. 166,[174][175][176][177][178][179][180][181]184,185,188,189,[191][192][193][194][195][196][197][198][199][200][201][202][203][204][205][206]. What is an algorithm for treatment of adult patients with ureteral stones?…”

Super‐mini percutaneous nephrolithotomy (SMP) vs retrograde intrarenal surgery for the treatment of 1–2 cm lower‐pole renal calculi: an international multicentre randomised controlled trial

“…Taking the higher risk of complications associated with standard PNL into account, endourologists aimed to decrease the rate of severe complications (mainly bleeding) by using reduced tract sizes to limit the trauma induced in the renal parenchyma . With this concept of reducing the risk of PNL‐related complications, we developed the super‐mini‐PNL (SMP), which refers to an access sheath size of 10–14 F. It provides a safe and effective treatment method for renal calculi of ≤2.5 cm .…”

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

“…Minimally invasive PCNL (also termed mini-PCNL or mini-Perc or mPCNL), a miniature endoscope via a small percutaneous tract (11–20 Fr), is widely executed in the recent years [2, 3]. Mini-PCNL was described by Helal et al Firstly performed on a 2-year-old child by the use of instruments with smaller access diameters in 1997 and developed by Jackman et al to be a therapy option for adults [4, 5] compared to the standard tract PCNL, mini-PCNL has a more gracile tract of <20 Fr, which leads to less nephron loss and other postoperative complications; meanwhile the stone-free rate seems to have no significant difference [6, 7]. …”