Percutaneous nephrolithotomy vs. retrograde intrarenal surgery for renal stones larger than 2cm in patients with a solitary kidney: A systematic review and a meta-analysis

Abstract

Background: The safety and feasibility of percutaneous nephrolithotomy (PCNL) compared with retrograde intrarenal surgery (RIRS) are debated. This systematic evaluation was performed to obtain comprehensive evidence with regard to the treatment outcomes of PCNL compared with RIRS for management of renal stones in patients with solitary kidney. Methods: A systematic search of Medline, Embase, Pubmed, and the Cochrane Library was performed to identify studies that compared PCNL with RIRS. Outcomes of interest included perioperative variables, complications, and stone-free rate (SFR). Results: 4 studies assessing PCNL vs. RIRS were included for meta-analysis. Although patients underwent PCNL have higher initial SFR than RIRS (OR: 3.72, 95% CI:2.38 to 5.83; P＜0.001), patients underwent RIRS have less intraoperative blood loss (dropped Hb: WMD= 3.49 g/L, 95% CI:2.83 to 4.15; P＜0.001), lower blood transfusion rates (OR= 5.31, 95% CI:1.36 to 20.68; P=0.02), and higher incidence rate of steinstrasse (OR:0.20, 95% CI:0.04 to 0.91; P=0.04). All the other calculated results including operation time (WMD: -9.87 minute, 95% CI:-30.11 to 10.37; P=0.34), final SFR (OR:1.65, 95% CI:0.80 to 3.42;P=0.18) and overall complications (OR:1.22, 95% CI:0.78 to 1.93; P=0.38) are similar between the two groups. Conclusions: Our results indicate that PCNL has higher initial SFR than RIRS in the treatment of renal stones in patients with a solitary kidney; the overall complications were comparable in both groups. However, RIRS, with less blood loss and transfusion rate, may be an alternative in selected patients.

Comparative Evaluation Between One Ultrasonic and Two Single-Probe Dual-Energy Lithotripters: In Vitro and In Vivo Experiment in a Porcine Model

“…Thus, keeping the procedure short could probably increase the safety and lead to a decreased rate of complications. 16,17 Stone treatment with smaller-diameter probes resulted in significantly slower SCTs than working with bigger-diameter probes of the same devices. The only exception was related to the Lithoclast Master: Although the bigger probe was faster during the trials, the outcome was not statistically significant, underlining a potential small difficulty of this device to treat hard stones regardless of the diameter of the probes.…”

The comparison of perioperative outcomes between percutaneous nephrolithotomy and retrograde intrarenal surgery in elderly patients

“…RIRS has been widely used to treat renal stones >2 cm by several investigators. 3,4 So, for renal stone between 10 and 30 mm, RIRS and PCNL are both options, and the choice of treatment will depend on anatomical and stone characteristics. However, surgical complications are associated with PCNL; therefore, for elderly patients, minimally invasive procedures, especially RIRS, are preferable.…”

“…According to EAU guideline, PCNL is the standard treatment for renal stones >2 cm, and RIRS and shock wave lithotripsy ( SWL) for renal stones <2 cm 2 . However, despite the recommendations of the EAU guideline on management of renal stones, RIRS has been widely used to treat renal stones >2 cm by several investigators 3,4 . So, for renal stone between 10 and 30 mm, RIRS and PCNL are both options, and the choice of treatment will depend on anatomical and stone characteristics.…”

Effect of Charlson comorbidity index on complications and outcomes following Percutaneous nephrolithotomy and Retrograde intrarenal surgery in elderly patients

“…2 However, despite the recommendations of the EAU guideline on management of renal stones, RIRS has been widely used to treat renal stones > 2 cm by several investigators. 3,4 So, for renal stone between 10 and 30 mm, RIRS and PCNL are both options, and the choice of treatment will depend on anatomical and stone characteristics. However, surgical complications are associated with PCNL, therefore, for elderly patients, minimally invasive procedures, especially RIRS, are preferable.…”