Systematic Review and Meta-Analysis Comparing Percutaneous Nephrolithotomy, Retrograde Intrarenal Surgery and Shock Wave Lithotripsy for Lower Pole Renal Stones Less Than 2 cm in Maximum Diameter

Abstract

The aim of the current systematic review and meta-analysis is to provide an answer on which is the most appropriate approach for the management of the lower pole stones with a maximal dimension of 2 cm or less. Materials and Methods: A systematic review was conducted on PubMedÒ, SCOPUSÒ, Cochrane and EMBASEÒ. The PRISMA guidelines and the recommendations of the EAU Guidelines office were followed. Retrograde intrarenal surgery, shock wave lithotripsy and percutaneous nephrolithotomy were considered for comparison. The primary end point was the stone-free rate. Results: A total of 15 randomized controlled trials were eligible. Percutaneous nephrolithotripsy and retrograde intrarenal surgery have higher stone-free rates in comparison to shock wave lithotripsy and require fewer re-treatment sessions. Operative time and complications seem to favor shock wave lithotripsy in comparison to percutaneous nephrolithotripsy, but this takes place at the expense of multiple shock wave lithotripsy sessions. Retrograde intrarenal surgery seems to be the most efficient approach for the management of stones up to 1 cm in the lower pole. Conclusions: The pooled analysis of the eligible studies showed that the management of lower pole stones should probably be percutaneous nephrolithotripsy or retrograde intrarenal surgery to achieve stone-free status over a short period and minimal number of sessions. For stones smaller than 10 mm, retrograde intrarenal surgery is more efficient in comparison to shock wave lithotripsy. The decision between the 2 approaches (percutaneous nephrolithotripsy or retrograde intrarenal surgery) should be individual, based on the anatomical parameters, the comorbidity and the preferences of each patient.

A Comparative Study of Percutaneous Nephrolithotripsy and Extracoeporeal Shockwave Lithotripsy For The Treatment of Lower Pole Kidney Stone of Size 10-20 mm

“…The rate was significantly higher in PCNL group when compared to ESWL group. This findings has been supported by the study of Montadhar H et al 22 , Elspeth M et al 23 24 Furthermore, mean operation time were significantly higher in PCNL group than ESWL group which is also supported by the study of Kallidonis P 24 and Montadhar H et al 22 The present study showed that the rate of haematuria in PCNL group was significantly higher than ESWL group however in the study of Montadhar H et al 22 and Sheng HanTsai 9 the difference were not significant for rate of haematuria. There were no statistically significant differences between the PCNL and ESWL groups for other post-operative complications such as, blood transfusion, obstruction and fever.…”

“…, Kallidonis P24 , Bozzin G et al25 , Tayfun S et.al7 and Albala DM26 Based on the above reviews and our result it is revealed that the success rate of PCNL is 84.2 % to 95% while success rate of ESWL is varied form 27% to 67.65%. Meanwhile, study of Gurocak S et al27 showed that lower pole stone treatment by ESWL has shown a large variation for stone free rate from 25% to 85% .…”

“…Likewise our observation, studies of James FD 5 ,Albala DM et al26 , Chaussy C 17 and Panogiotis K 24 mentioned that PCNL was more effective than ESWL for the treatment of lower pole stone of size 10-20 m and ESWL was less effective for removal of stone size greater than 10mm. Similarly, the study Kallidonis P24 , Bozzin G et al25 , Albala D et.al26 and Sheng Han Tsai9 have also shown that retreatment rate was higher in ESWL group when compared with PCNL. Likewise, the study of Bozzin et.al.…”

Study on Clinical Application of Different Ultrasound-Guided Planar Techniques in Minimally Invasive Percutaneous Nephrolithotomy

“…[10][11][12] Complications such as bleeding, infection, peripheral organ damage, and peripheral exudate were significantly lower than those reported in other related literature studies. 13,14 The low complication rate was closely related to the establishment of an ideal percutaneous renal channel.…”

Contemporary considerations in the management and treatment of lower pole stones

“…As there is no active extraction process involved with this procedure, stone-free rates are generally lower for SWL than for RIRS or PCNL (18,19). There is mounting evidence to suggest that this trend is observed, and perhaps even amplified, when limited to lower pole stones (20,21). This is because the residual fragments after SWL often remain in the lower pole, thereby resulting in recurrent stone formation.…”