Is endoscopic combined intrarenal surgery ready for primetime in endourology? Outcomes from a systematic review and meta-analysis.

We aimed to review the outcomes of endoscopic combined intrarenal surgery (ECIRS) as compared to conventional percutaneous nephrolithotomy (PCNL) for kidney stones.

We performed a systematic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. We included all studies comparing ECIRS and conventional PCNL. Surgical time, hemoglobin drop, and postoperative stay were pooled using the inverse variance of the mean difference (MD) with a random effect, 95% confidence intervals (CI), and p-values. Complications, stone-free rate, and retreatment were assessed using Cochran-Mantel-Haenszel method with random effect model and expressed as odds ratio (OR), 95% CI, and p-values.

A total of 17 studies were included. Surgical time and mean postoperative length did not significantly differ between the groups (MD -8.39 minutes 95%CI -21.30, 4.53, p = 0.20; 5.09 days 95%CI -19.51, 29.69, p = 0.69). Mean hemoglobin drop was significantly lower in the ECIRS group (MD -0.56 g/dl 95%CI -1.08, -0.05, p = 0.03), while blood transfusion rate did not differ between the two groups (OR 0.88 95%CI 0.64, 1.23, p = 0.15). While the incidence of postoperative sepsis did not differ between the two groups (OR 0.52 95% CI 0.17, 1.59, p = 0.25), the incidence of postoperative fever was lower in the ECIRS group but the difference was not significant (OR 0.61 95%CI 0.35, 1.06, p = 0.08). The stone-free rate was significantly higher in the PCNL group (OR 2.52 95%CI 1.64, 3.90, p <0.0001) and the retreatment rate was lower in the ECIRS group (OR 0.34 95%CI 0.14, 0.87, p = 0.002).

ECIRS showed shorter operative time, lower complication rate, and retreatment compared to PCNL. Conventional PCNL showed a higher stone-free rate.

Central European journal of urology. 2022 Apr 29 [Epub]

Vineet Gauhar, Daniele Castellani, Cecilia Maria Cracco, Cesare Marco Scoffone, Ee Jean Lim, Emanuele Rubilotta, Eugenio Pretore, Giacomo Maria Pirola, Martina Maggi, Patrick Rice, Vinson Wai-Shun Chan, Jeremy Yuen-Chun Teoh, Chin-Tiong Heng, Bhaskar Kumar Somani, Maria Pia Pavia

Department of Urology, Ng Teng Fong General Hospital, Singapore., Faculty of Medicine, School of Urology, Polytechnic University of the Marche Region, Ancona, Italy., Department of Urology, Cottolengo Hospital, Torino, Italy., Department of Urology, Singapore General Hospital, Singapore., Department of Urology, Azienda Ospedaliero Universitaria of Verona, University of Verona, Verona, Italy., Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy., Department of Urology, San Giuseppe Hospital, Multimedica Group, Milan, Italy., Department of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy., Academic Foundation Doctor, University Hospital Southampton NHS Trust, Southampton, United Kingdom., School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom., S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.

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