Mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the treatment of 10-20 mm lower pole renal stones: a systematic review and meta-analysis.

To compare the efficacy and safety of mini-percutaneous nephrolithotomy (mini-PCNL) versus retrograde intrarenal surgery (RIRS) for treatment of 10-20 mm lower pole renal stones.

A comprehensive literature search of PubMed, Scopus, the Cochrane Library, and Web of Science was conducted to identify all studies comparing mini-PCNL and RIRS for 10-20 mm lower pole renal stones before March 2019. Article selection proceeded according to the search strategy based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The meta-analysis was performed with the R program version 3.5.1.

A total of five studies were included (two randomized controlled trials and three case-controlled trials) with a total of 587 patients included. The success rate was significantly higher in the mini-PCNL group (OR 1.67; 95% CI p = 0.05). Operative and fluoroscopy times were similar for both groups (MD 2.45; 95% CI p = 0.87 and MD 2.11; 95% CI p = 0.09, respectively). Concerning the hospital stay and overall complication rates, there were no differences between the two procedures (MD 41.94; 95% CI p = 0.18 and OR 1.76; 95% CI p = 0.11).

Our analysis showed that both procedures are safe for treatment of 10-20 mm lower pole renal stones with similar complication rates, operative times, fluoroscopy times and length of hospital stay, but mini-PCNL was significantly superior in effectiveness with a higher success rate. Based on these results, mini-PCNL may be included in the guidelines as a safe and effective alternative treatment for 10-20 mm lower pole stones.

World journal of urology. 2019 Dec 07 [Epub ahead of print]

José D Cabrera, Braulio O Manzo, José E Torres, Fabio C Vicentini, Héctor M Sánchez, Ernesto A Rojas, Edgard Lozada

Department of Nephrology-Urology, Hospital Regional de Alta Especialidad Del Bajío, San Carlos La Roncha, 37660, León, Guanajuato, Mexico., Department of Nephrology-Urology, Hospital Regional de Alta Especialidad Del Bajío, San Carlos La Roncha, 37660, León, Guanajuato, Mexico. ., Faculdade de Medicina, Universidade de Sao Paulo, Hospital das Clinicas and Brigadeiro Hospital, São Paulo, Brasil., Facultad de Estudios Superiores, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico.