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Percutaneous nephrolithotomy vs retrograde intrarenal surgery for renal stones: a Cochrane Review

Objectives: To assess the effects of percutaneous nephrolithotomy (PCNL) vs retrograde intrarenal surgery (RIRS) for the treatment of renal stones in adults.

Methods: We performed a comprehensive search of the Cochrane Library, MEDLINE, Embase, three other databases, trials registries, other sources of the grey literature, and conference proceedings up to 23 March 2023. We applied no restrictions on publication language or status. Screening, data extraction, risk-of-bias assessment, and certainty of evidence (CoE) rating using the Grading of Recommendations Assessment, Development, and Evaluations (GRADE) approach were done in duplicate by two independent reviewers. This co-publication focuses on the primary outcomes of this review only.

Results: We included 42 trials that met the inclusion criteria. Stone-free rate (SFR): PCNL may improve SFRs (risk ratio [RR] 1.13, 95% confidence interval [CI] 1.08-1.18; I2 = 71%; 39 studies, 4088 participants; low CoE). Major complications: PCNL probably has little to no effect on major complications (RR 0.86, 95% CI 0.59-1.25; I2 = 15%; 34 studies, 3649; participants; moderate CoE) compared to RIRS. Need for secondary interventions: PCNL may reduce the need for secondary interventions (RR 0.31, 95% CI 0.17-0.55; I2 = 61%; 21 studies, 2005 participants; low CoE) compared to RIRS.

Conclusion: Despite shortcomings in most studies that lowered our certainty in the estimates of effect to mostly very low or low, we found that PCNL may improve SFRs and reduce the need for secondary interventions while not impacting major complications. Ureteric stricture rates may be similar compared to RIRS. We expect the findings of this review to be helpful for shared decision-making about management choices for individuals with renal stones.

Leah Soderberg,1 Onuralp Ergun,2,3 Maylynn Ding,4 Robin Parker,5 Michael Borofsky,3 Vernon Pais,6 Philipp Dahm2,3

  1. Department of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA.
  2. Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA.
  3. Department of Urology, University of Minnesota, Minneapolis, MN, USA.
  4. School of Medicine, McMaster University, Hamilton, ON, Canada.
  5. W.K. Kellogg Health Sciences Library, Dalhousie University, Halifax, NS, Canada.
  6. Department of Surgery, Dartmouth Medical School, Lebanon, NH, USA.
Source: Soderberg L., Ergun O., Ding M. et al. Percutaneous nephrolithotomy vs retrograde intrarenal surgery for renal stones: a Cochrane Review. BJU Int. 2024 Feb;133(2):132-140. doi: 10.1111/bju.16220.