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A systematic review and meta-analysis of minimally invasive vs. standard percutaneous nephrolithotomy in the surgical management of renal stones

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单位: [1]Department of Urology, China‑Japan Friendship Hospital, Beijing 100029 [2]Graduate School, PekingUnion Medical College and Chinese Academy of Medical Sciences, Beijing 100730 [3]Medical College, Peking UniversityChina‑Japan Friendship School of Clinical Medicine, Beijing 100029 [4]Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
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关键词: percutaneous nephrolithotomy minimally invasive percutaneous nephrolithotomy renal stones mini percutaneous nephrolithotomy

摘要:
The present study aimed to assess current evidence on the effectiveness and safety of minimally invasive vs. standard percutaneous nephrolithotomy (PCNL) in the management of renal stones. A systematic search of electronic databases, which included PubMed, EMBASE and the Cochrane Library up to May 2019 was performed. Using Review Manager statistical software (version 5.3), primary outcomes, including stone-free rates (SFRs), were evaluated. Meanwhile, analysis was also performed to compare secondary outcomes, such as peri- and postoperative complications and operative data. Fourteen studies involving 1,611 patients with renal stones were analyzed based on the inclusion criteria. On the basis of the present analysis, mini percutaneous nephrolithotomy (MPCNL) was proven to have non-inferior clinical efficacy with respect to the SFR compared with PCNL [odds ratio (OR)=1.10; 95% confidence interval (CI), 0.84-1.44; P=0.48]. In addition, the meta-analysis showed that MPCNL had a significantly lower hemoglobin decrease [mean difference (MD)=-0.68; 95% CI, -1.05 to -0.31; P=0.0003] and fewer blood transfusions (OR=0.36; 95% CI, 0.18-0.71; P=0.003) compared with PCNL. Moreover, the MPCNL group had a shorter inpatient stay (MD=-0.81; 95% CI, -1.55 to -0.08; P=0.03) compared with the PCNL group. However, the overall evidence was insufficient to suggest a statistically significant difference in the adverse event profile for MPCNL compared with PCNL. The present meta-analysis indicates that MPCNL is an effective method for treating renal stones. Compared with PCNL, MPCNL not only has similarly high SFRs but is also associated with less blood loss, fewer blood transfusions, more favorable recovery time and shorter inpatient stays. However, the findings of the present study should be further confirmed by well-designed prospective randomized controlled trials with a larger patient series.

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出版当年[2020]版:
大类 | 4 区 医学
小类 | 4 区 医学:研究与实验
最新[2025]版:
大类 | 4 区 医学
小类 | 4 区 医学:研究与实验
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出版当年[2019]版:
Q4 MEDICINE, RESEARCH & EXPERIMENTAL
最新[2023]版:
Q3 MEDICINE, RESEARCH & EXPERIMENTAL

影响因子: 最新[2023版] 最新五年平均[2021-2025] 出版当年[2019版] 出版当年五年平均[2015-2019] 出版前一年[2018版] 出版后一年[2020版]

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第一作者单位: [1]Department of Urology, China‑Japan Friendship Hospital, Beijing 100029 [2]Graduate School, PekingUnion Medical College and Chinese Academy of Medical Sciences, Beijing 100730
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通讯机构: [1]Department of Urology, China‑Japan Friendship Hospital, Beijing 100029 [2]Graduate School, PekingUnion Medical College and Chinese Academy of Medical Sciences, Beijing 100730 [3]Medical College, Peking UniversityChina‑Japan Friendship School of Clinical Medicine, Beijing 100029 [4]Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China [*1]Department of Urology, China-Japan Friendship Hospital, 2 Yinghuadong Road, Beijing 100029, P.R. China [*2]Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 325 Five Weft Seven Road, Jinan, Shandong 250021, P.R. China
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