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Comparison between retrograde intrarenal surgery and percutaneous nephrolithotripsy in the management of renal stones: A meta‑analysis

  • Authors:
    • Ming Zhu
    • Xiaoyi Wang
    • Zhanqin Shi
    • Min Ding
    • Deyong Fan
    • Xiang Wang
    • Rui Jiang
  • View Affiliations / Copyright

    Affiliations: Nephrology Department, First Affiliated Hospital, Huzhou Teachers College, The First People's Hospital of Huzhou, Huzhou, Zhejiang 313000, P.R. China, Nephrology Department, Huzhou Central Hospital, Huzhou, Zhejiang 313003, P.R. China
    Copyright: © Zhu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Pages: 1366-1374
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    Published online on: June 25, 2019
       https://doi.org/10.3892/etm.2019.7710
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Abstract

Percutaneous nephrolithotripsy (PCNL) is recommended as the first‑line treatment for the management of kidney stones that are ≥2 cm in diameter. Retrograde intrarenal surgery (RIRS) has become increasingly preferred due to its high level of safety and repeatability, particularly in small stones. However, whether PCNL has superior efficacy and lower complication rates when compared with RIRS remains controversial. Therefore, the present meta‑analysis was conducted to compare the clinical outcomes of patients treated with PCNL and RIRS as therapy for renal stones. Clinical trials published in PubMed, Web of Science, Excerpta Medica dataBASE (EMBASE), and the Chinese Biomedical Database (CBM) were systematically reviewed to evaluate the efficacy and safety profiles of patients with renal stones who were treated with PCNL or RIRS. Main outcomes measures included stone‑free rate, operative time, hospital stay, and complication rate. Results were expressed as risk ratio (RR), or weighted mean difference (WMD) with 95% confidence intervals (CIs). Pooled estimates were calculated using a fixed‑effects or random‑effects model according to the heterogeneity among the studies. In total, 17 studies [4 randomized controlled trials (RCTs) and 13 cohort studies] involving 1,717 patients met the inclusion criteria, and were included in this meta‑analysis. Pooled results showed that PCNL exhibited a significantly higher stone‑free rate (RR=0.90, 95% CI: 0.86 to 0.95; P<0.001) but was associated with a longer hospital stay, when compared with RIRS (WMD=‑2.72, 95% CI: ‑3.9 to ‑1.54; P<0.001). Operative time (WMD=7.86, 95% CI: ‑0.89 to 16.61; P=0.078) and complication rate (RR=0.71, 95% CI: 0.48 to 1.05; P=0.083) did not significantly differ between the groups. Subgroup analysis revealed that PCNL had a shorter operation time than RIRS in patients with stone sizes ≥2 cm (WMD=12.88, 95% CI: 4.77 to 20.99; P=0.002), and PCNL had a similar stone‑free rate as RIRS when the estimates were pooled from RCTs (RR=0.88, 95% CI: 0.76 to 1.01; P=0.078). Compared with PCNL, RIRS had a significantly lower stone‑free rate, shorter hospital stay, but a similar operation time and complication rate. Therefore, we propose that RIRS may be an alternative therapy to PCNL, with acceptable efficacy and complication rates for renal stones. Further large‑scale, well‑conducted RCTs are required to verify our findings.
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Copy and paste a formatted citation
Spandidos Publications style
Zhu M, Wang X, Shi Z, Ding M, Fan D, Wang X and Jiang R: Comparison between retrograde intrarenal surgery and percutaneous nephrolithotripsy in the management of renal stones: A meta‑analysis. Exp Ther Med 18: 1366-1374, 2019.
APA
Zhu, M., Wang, X., Shi, Z., Ding, M., Fan, D., Wang, X., & Jiang, R. (2019). Comparison between retrograde intrarenal surgery and percutaneous nephrolithotripsy in the management of renal stones: A meta‑analysis. Experimental and Therapeutic Medicine, 18, 1366-1374. https://doi.org/10.3892/etm.2019.7710
MLA
Zhu, M., Wang, X., Shi, Z., Ding, M., Fan, D., Wang, X., Jiang, R."Comparison between retrograde intrarenal surgery and percutaneous nephrolithotripsy in the management of renal stones: A meta‑analysis". Experimental and Therapeutic Medicine 18.2 (2019): 1366-1374.
Chicago
Zhu, M., Wang, X., Shi, Z., Ding, M., Fan, D., Wang, X., Jiang, R."Comparison between retrograde intrarenal surgery and percutaneous nephrolithotripsy in the management of renal stones: A meta‑analysis". Experimental and Therapeutic Medicine 18, no. 2 (2019): 1366-1374. https://doi.org/10.3892/etm.2019.7710
Copy and paste a formatted citation
x
Spandidos Publications style
Zhu M, Wang X, Shi Z, Ding M, Fan D, Wang X and Jiang R: Comparison between retrograde intrarenal surgery and percutaneous nephrolithotripsy in the management of renal stones: A meta‑analysis. Exp Ther Med 18: 1366-1374, 2019.
APA
Zhu, M., Wang, X., Shi, Z., Ding, M., Fan, D., Wang, X., & Jiang, R. (2019). Comparison between retrograde intrarenal surgery and percutaneous nephrolithotripsy in the management of renal stones: A meta‑analysis. Experimental and Therapeutic Medicine, 18, 1366-1374. https://doi.org/10.3892/etm.2019.7710
MLA
Zhu, M., Wang, X., Shi, Z., Ding, M., Fan, D., Wang, X., Jiang, R."Comparison between retrograde intrarenal surgery and percutaneous nephrolithotripsy in the management of renal stones: A meta‑analysis". Experimental and Therapeutic Medicine 18.2 (2019): 1366-1374.
Chicago
Zhu, M., Wang, X., Shi, Z., Ding, M., Fan, D., Wang, X., Jiang, R."Comparison between retrograde intrarenal surgery and percutaneous nephrolithotripsy in the management of renal stones: A meta‑analysis". Experimental and Therapeutic Medicine 18, no. 2 (2019): 1366-1374. https://doi.org/10.3892/etm.2019.7710
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