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

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Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

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Authors and Affiliations

  1. Department of Nephrology-Urology, Hospital Regional de Alta Especialidad Del Bajío, San Carlos La Roncha, 37660, León, Guanajuato, Mexico

    José D. Cabrera, Braulio O. Manzo, José E. Torres, Héctor M. Sánchez & Edgard Lozada

  2. Faculdade de Medicina, Universidade de Sao Paulo, Hospital das Clinicas and Brigadeiro Hospital, São Paulo, Brasil

    Fabio C. Vicentini

  3. Facultad de Estudios Superiores, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico

    Ernesto A. Rojas

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  1. José D. Cabrera
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  5. Héctor M. Sánchez
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JDC: Protocol/project development, data collection or management, data analysis, manuscript writing/editing; BOM: Protocol/project development, data collection or management, data analysis, manuscript writing/editing; JET: Data collection or management; FV: Manuscript writing/editing; HMS: Manuscript writing/editing; EAR: Statistical analysis; EL: Statistical analysis.

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Correspondence to Braulio O. Manzo.

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Cabrera, J.D., Manzo, B.O., Torres, J.E. et al. Mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the treatment of 10–20 mm lower pole renal stones: a systematic review and meta-analysis. World J Urol 38, 2621–2628 (2020). https://doi.org/10.1007/s00345-019-03043-8

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