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Determining the safety and effectiveness of percutaneous nephrolithotomy and retrograde intrarenal surgery in treating nephrolithiasis in patients with solitary kidneys

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Abstract

We performed a meta-analysis to compare the safety and effectiveness of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in treating nephrolithiasis ≥ 2 cm in patients with solitary kidneys. This systematic review was registered on PROSPERO (registration ID: CRD42021270519). The search time was set from the establishment of the databases until April 30, 2021. A systematic search was performed in the PubMed, MEDLINE, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), Cochrane Library, and Embase databases. Stata 16 was used to perform the statistical analysis of the extracted data. After screening using strict inclusion and exclusion criteria, five studies with a total of 474 patients were included in the final meta-analysis. According to the literature quality assessment scale statistics, the five studies included were of high quality. The results of the meta-analysis showed that RIRS had lesser hemoglobin loss (HL), shorter length of hospital stay (LOS), lower initial (OR = 3.39, 95% CI [1.97, 5.83], P = 0.02) and final stone-free rates (OR = 2.24, 95% CI [1.24, 4.06], P = 0.03), but a higher incidence of grade III-IV complications (OR = 0.29, 95% CI [0.08, 0.97], P = 0.04) than PCNL. The difference between the two surgical methods was not statistically significant in terms of operation time (OT), grade I–II complication rate, and total complication rate. For nephrolithiasis ≥ 2 cm in patients with a solitary kidney, RIRS has the advantage of less HL and shorter LOS, while PCNL benefits from its higher SFR (both initial and final). Both RIRS and PCNL are effective treatments for nephrolithiasis in patients with a solitary kidney, and clinicians should choose the most appropriate option to achieve the best treatment outcome, taking into account the patient's underlying conditions and medical conditions.

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Acknowledgements

The authors thank Mrs. Xinnan Gou for providing continuous encouragement to Dr. Lei Peng in his career in medicine.

Funding

This work was supported by the Sichuan Province Science and Technology Planning Project under grant number 2020YFS0320 and the Sichuan Provincial Health Committee Research Project under grant number 20PJ305.

Author information

Author notes

  1. Lei Peng, Chunyang Meng, Zhongyou Xia and Rui Liang have contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Nanchong Central Hospital, Department of Urology, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China

    Lei Peng, Chunyang Meng, Zhongyou Xia, Lijian Gan, Kangsen Li & Yunxiang Li

  2. Department of Urology, The Second Hospital of Lanzhou University Medical School, LanzhouGansu, 730000, China

    Lei Peng

  3. Institute of Urology, Clinical Laboratory, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen, 518000, China

    Lei Peng

  4. South China Hospital, Health Science Center, The Affiliated Hospital of Shenzhen University, Shenzhen, 518000, China

    Lei Peng

  5. Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China

    Rui Liang

  6. Institute of Urology, Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Dehong Cao

  7. State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, 610041, Sichuan, China

    Dehong Cao

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  1. Lei Peng
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Contributions

YL and DC conceived and designed the experiments. LP, CM, ZX analyzed the data. LG, KL contributed to reagents/material/analysis. LP, CM wrote the manuscript. All the authors have read and approved the final manuscript

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Correspondence to Dehong Cao or Yunxiang Li.

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Peng, L., Meng, C., Xia, Z. et al. Determining the safety and effectiveness of percutaneous nephrolithotomy and retrograde intrarenal surgery in treating nephrolithiasis in patients with solitary kidneys. Urolithiasis 51, 2 (2023). https://doi.org/10.1007/s00240-022-01386-3

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