Investig Clin Urol.  2020 Mar;61(2):115-126. 10.4111/icu.2020.61.2.115.

The efficacy and safety of miniaturized percutaneous nephrolithotomy versus standard percutaneous nephrolithotomy: A systematic review and meta-analysis of randomized controlled trials

• Feng D
• Hu X
• Tang Y
• Han P
• Wei X

• KMID: 2471067
• DOI: http://doi.org/10.4111/icu.2020.61.2.115

Abstract

PURPOSE
Our aim was to assess the efficacy and safety of miniaturized percutaneous nephrolithotomy (mPCNL) versus standard PCNL (sPCNL) to provide higher-level evidence.
MATERIALS AND METHODS
Eligible randomized controlled trials were identified from electronic databases. The data analysis was performed by the Cochrane Collaboration's software RevMan 5.3.
RESULTS
A total of 1,219 patients from 9 articles published between 2004 and 2019 were included. Compared with those who received sPCNL, patients who received mPCNL experienced a higher stone-free rate (SFR) (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.03-1.99; p=0.03), lower transfusion rates (OR, 0.33; 95% CI, 0.17-0.63; p=0.0007), and lower drops in hemoglobin (mean difference [MD], −0.72; 95% CI, −1.04 to −0.40; p<0.00001), but the operative time seemed to be significantly longer (MD, 10.98; 95% CI, 3.64-18.32; p=0.003). Of note, there was no significant difference between the two groups regarding the SFR (p=0.09) for renal calculi ≥2 cm. In addition, the meta-analysis results showed no significant differences between the groups regarding urine leakage (p=0.60), postoperative fever (p=0.71), impaired ventilation (p=0.97), or total complications (p=0.29) with no heterogeneity between trials. These results remain unaffected with regard to renal calculi ≥2 cm.
CONCLUSIONS
Our findings suggested that mPCNL had a higher SFR than sPCNL and there was no significant difference between the two groups for renal stones ≥2 cm. Besides, mPCNL tended to be associated with significantly less bleeding and a lower transfusion rate, but the duration of the procedure seemed to be significantly longer.

Keyword

Meta-analysis; Minimally invasive surgical procedures; Nephrolithotomy, percutaneous; Randomized controlled trial

MeSH Terms

Fever
Hemorrhage
Humans
Kidney Calculi
Minimally Invasive Surgical Procedures
Nephrostomy, Percutaneous*
Operative Time
Population Characteristics
Statistics as Topic
Ventilation

Figure

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  Fig. 1 (A, B) The risk of bias by use of the Cochrane Collaboration's tools [47891011121314].

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  Fig. 2 The study selection process [19]. RCTs, randomized controlled trials.

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  Fig. 3 (A–I) The pooled results of the primary and secondary outcomes. mPCNL, miniaturized percutaneous nephrolithotomy; sPCNL, standard percutaneous nephrolithotomy; M–H, Mantel–Haenszel; CI, confidence interval; IV, inverse variance.

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  Fig. 4 (A–H) Results of the meta-analysis of renal calculi ≥2 cm. Complications were stratified by the Clavien–Dindo system into minor (grade 1–2) and major (grade 3–5) complications [20]. mPCNL, miniaturized percutaneous nephrolithotomy; sPCNL, standard percutaneous nephrolithotomy; M–H, Mantel–Haenszel; CI, confidence interval; IV, inverse variance.

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