The fight between PCNL, laparoscopic and robotic pyelolithotomy: do we have a winner? A systematic review and meta-analysis.

The aim of this systematic review and meta-analysis is to provide an updated comparison between the currently available minimally invasive approaches (PCNL, laparoscopic [LP] and robotic pyelolithotomy [RP]) for the management of large renal stones.

An electronic search of the current literature was conducted through the Medline and NCBI PubMed, Embase, Scopus and Cochrane Collaboration Central Register of Controlled Clinical Trials databases in March 2021. Studies about minimally-invasive treatment for kidney stones were considered. Inclusion criteria were: studies evaluating patients with large renal calculi (≥2 cm); the comparison of at least two of the three approaches (PCNL, LP, RP), reporting data suitable for meta-analysis evaluation. Patients with concomitant management for ureteropelvic junction obstruction (UPJ-O) were excluded.

Overall, 17 reports were considered for qualitative and quantitative synthesis, for a total cohort of 1079 patients, of which 534 with PCNL, 525 treated with LP, and 20 with RP. Of those, 16 compared PCNL with LP, while only 1 study compared LP with RP. PCNL mean operative time was statistically significantly shorter than LP and RP while mean estimated blood loss was statistically significantly higher for PNCL. No statistically significant differences were recorded among the three surgical approaches. Finally, PCNL demonstrated slightly, albeit statistically significant lower stone free rate when compared with LP.

PCNL, LP and RP may be safely and efficiently used to manage large renal stones. All three procedures showed reasonably low rate of complications with a satisfactory stone clearance rate.

Minerva urology and nephrology. 2022 Feb 11 [Epub ahead of print]

Guglielmo Mantica, Federica Balzarini, Francesco Chierigo, Etienne X Keller, Michele Talso, Esteban Emiliani, Amelia Pietropaolo, Rocco Papalia, Roberto M Scarpa, Carlo Terrone, Francesco Esperto

Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy., Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy - ., Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland., Young Academic Urologists (YAU) Urolithiasis & Endourology working party., Department of Urology, Campus Biomedico University of Rome, Rome, Italy., European Society of Residents in Urology (ESRU).

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