Is Retrograde Intrarenal Surgery Better Than Percutaneous Nephrolithotomy for Treatment of Renal Stones >2 cm? A Systematic Review and Meta-Analysis
Bin Xie, Chao Lu, Yongshi Qi, Changwen Zhang, Hao Ding, Yong Xu
Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China (mainland)
Med Sci Rev 2015; 2:143-149
Percutaneous nephrolithotomy (PCNL) has long been the first choice for the management of renal stones >2 cm, with high stone-free rate. Recently, retrograde intra-renal surgery (RIRS) has become widely used, with shorter hospital stay and similar stone-free rate. The aim of this study was to evaluate the efficacy and safety of RIRS versus PCNL for the treatment of renal calculi >2 cm.
MATERIAL AND METHODS: A systematic search of databases was conducted with the key words related to kidney stones: (“minimally invasive percutaneous nephrolithotomy” OR “MPCNL” OR “percutaneous nephrolithotomy” OR “PCNL” OR “micropercutaneous nephrolithotomy”) AND (“flexible ureteroscopy” OR “flexible URS” OR fURS OR RIRS OR “retrograde intrarenal surgery” OR “flexible nephroscopy”) from their establishment to July 21, 2015. Odds ratios (ORs) or weighted mean difference (WMD) and 95% confidence intervals (CIs) were used as the primary effect size.
RESULTS: One randomized and 10 nonrandomized studies were analyzed, involving 838 patients. The results indicated that the stone-free rate in the RIRS group was significantly lower than that in the PCNL group (OR: 0.40; 95%CI: 0.27 to 0.61; P<0.05), with a significantly shorter hospital stay (WMD: –2.34; 95%CI: –3.30 to –1.38; p<0.05). In contrast, RIRS led to a significantly longer operative time (WMD: 17.85; 95%CI: 8.70 to 26.99; p<0.05). In subgroup analysis, the stone-free rate in the RIRS group was significantly lower than that in the mPCNL group (OR: 0.21; 95%CI: 0.11 to 0.42; p<0.05), but no differences existed between RIRS and standard PCNL (OR: 0.61; 95%CI: 0.36 to 1.03; P>0.05). Operation time was longer with RIRS than with mPCNL (WMD: 10.95; 95%CI: 7.21 to 14.69; p<0.05) and standard PCNL (WMD: 19.54; 95%CI: 8.62 to 30.46; p<0.05). The complication rate was not different between RIRS and PCNL, including mPCNL (OR: 1.41; 95% CI: 0.70 to 2.84, p>0.05) and standard PCNL (OR: 7.2; 95% CI: 0.42 to 1.23; p>0.05).
CONCLUSIONS: The existing evidence indicates that retrograde intrarenal surgery has a shorter hospital stay, and percutaneous nephrolithotomy has a higher stone-free rate and a shorter operative time. In this regard, percutaneous nephrolithotomy should be considered the standard therapy for renal stones >2 cm.
Keywords: Meta-Analysis as Topic, Nephrostomy, Percutaneous, operative time, Postoperative Complications, Renal Insufficiency, Chronic