Retrograde Intrarenal Surgery Versus Miniaturized Percutaneous Nephrolithotomy for Kidney Stones >1cm: A Systematic Review and Meta-analysis of Randomized Trials.

Although miniaturized percutaneous nephrolithotomy (mPCNL) and retrograde intrarenal surgery (RIRS) are both options for treating >1cm kidney stones, controversies exist on whether one is more effective and safer than the other.

To systematically appraise randomized trials comparing the effectiveness and safety of mPCNL and RIRS for treating >1cm kidney stones.

A systematic search on PubMed/Medline, Web of Science, Embase, and ClinicalTrials.gov was conducted in August 2020 following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA). Randomized trials comparing mPCNL and RIRS for >1cm kidney stones, and reporting stone-free rate (SFR), hemoglobin drop, transfusion rate, length of hospital stay (LOS), and/or complications, were included.

Eight studies compared mPCNL and RIRS, but one was not included due to its high risk of bias. SFR was higher for mPCNL (RR: 1.06 [95% coefficient interval {CI}, 1.01-1.10], p=0.008). Hemoglobin drop was higher for mPCNL (mean difference [MD]: 0.35 [95% CI, 0.05-0.65] g/dl, p=0.02); however, transfusion rates were similar (p=0.44). Complication rate was similar between mPCNL and RIRS (p=0.39), and the LOS was higher for mPCNL (MD: 1.11 [95% CI, 0.06-2.16] d, p=0.04). A subgroup analysis of lower pole stones showed that SFR was higher for mPCNL (RR: 1.09 [95% CI, 1.00-1.19], p=0.05).

Both approaches are effective and safe. Among these approaches, mPCNL has a higher SFR than RIRS for overall >1cm renal and lower pole stones, but longer LOS, and a higher hemoglobin drop that does not translate into higher transfusion rates. Complications are comparable.

Randomized trials have evaluated whether miniaturized percutaneous nephrolithotomy (mPCNL) or retrograde intrarenal surgery is more effective and safer for treating >1cm stones. After comparing the stone-free rate, hemoglobin drop, transfusion rate, length of hospital stay, and complications between both the approaches, mPCNL was found to be slightly more effective, but both were equally safe.

European urology focus. 2021 Feb 21 [Epub ahead of print]

Luis Alberto Dorantes-Carrillo, Mario Basulto-Martínez, Rodrigo Suárez-Ibarrola, Alexander Heinze, Silvia Proietti, Juan Pablo Flores-Tapia, Antonio Esqueda-Mendoza, Guido Giusti

School of Medicine, Universidad Autónoma de Yucatán, Merida, Mexico., European Training Center in Endourology, Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy; Department of Urology, Hospital Regional de Alta Especialidad de la Península de Yucatán, Merida, Mexico. Electronic address: ., Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany., Department of Urology Kath, Marienkrankenhaus, Hamburg, Germany., European Training Center in Endourology, Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy., Division of Nephrology, Urology and Transplant Surgery, Hospital Regional de Alta Especialidad de la Península de Yucatán, Merida, Mexico., Department of Urology, Hospital Regional de Alta Especialidad de la Península de Yucatán, Merida, Mexico.

Go Beyond the Abstract and Read a Commentary by the Authors

email news signup