Percutaneous nephrolithotomy vs retrograde intrarenal surgery for renal stones: a Cochrane Review

Abstract

ObjectivesTo assess the effects of PCNL versus retrograde intrarenal surgery (RIRS) for the treatment of renal stones in adults.MethodsWe performed a comprehensive search of the Cochrane Library, MEDLINE, Embase, three other databases, trials registries, other sources of the grey literature, and conference proceeding up to March 23, 2023. We applied no restrictions on publication language or status. Screening, data extraction, risk of bias assessment and certainty of evidence (CoE) rating using GRADE were done in duplicate by two independent reviewers. This co‐publication focuses on the primary outcomes of this review only.ResultsWe included 42 trials that met the inclusion criteria.Stone free rate: PCNL may improve stone‐free rates (RR 1.13, 95% CI 1.08 to 1.18; I2 = 71%; 39 studies, 4088 participants; low CoE).Major complications: PCNL probably has little to no effect on major complications (RR 0.86, 95% CI 0.59 to 1.25; I2 = 15%; 34 studies, 3649; participants; moderate CoE) compared to RIRS.Need for secondary interventions: PCNL may reduce the need for secondary interventions (RR 0.31, 95% CI 0.17 to 0.55; I2 = 61%; 21 studies, 2005 participants; low CoE) compared to RIRS.ConclusionDespite shortcomings in most studies that lowered our certainty in the estimates of effect to mostly very low or low, we found that PCNL may improve stone‐free rates and reduce the need for secondary interventions while not impacting major complications. Ureteral stricture rates may be similar compared to RIRS. We expect the findings of this review to be helpful for shared decision‐making about management choices for individuals with renal stones.

Effect of infundibulopelvic angle on outcomes of ureteroscopy: a systematic review and meta-analysis

“…This makes logical sense, in that a long, narrow and steep lower pole is unlikely to be amenable to ureteroscopy, and therefore a percutaneous approach ought to be considered. A recent Cochrane review has suggested that PCNL may improve the SFR compared to ureteroscopy, with little effect on major complications and reduced need for secondary interventions, albeit with low certainty of evidence [ 30 ]. However, the IPA was not considered and therefore there may yet be a role for ureteroscopy.…”

Comparison between Micro- and Ultramini- Percutaneous Nephrolithotomy for the Treatment of 10-20 mm Kidney Stones in Preschool Children

“…Percutaneous nephrolithotomy (PCNL) has the superior e cacy and highest rate of monotherapeutic success in renal stone management. However, it is also associated with higher risk of injuries and complications when compared to extracorporeal shock wave lithotripsy (ESWL) and exible ureteroscopy [2,3]. According to the European Association of Urology (EAU) guidelines, PCNL is the primary treatment option for renal stones of size > 2 cm as well as lower pole stones > 1 cm [4].…”