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Minimally invasive versus standard percutaneous nephrolithotomy: a meta-analysis

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Abstract

The aim of the study was to objectively analyze the outcomes for minimally invasive percutaneous nephrolithotomy (MPCNL) vs standard percutaneous nephrolithotomy (PCNL) by systematic review and meta-analysis of published data. A systematic literature review was performed in November 2014 using the PUBMED, EMBASE and Cochrane Library databases to identify relevant studies. Only comparative studies investigating MPCNL vs PCNL were included. Effect sizes were estimated by pooled odds ratio (ORs) and mean differences (MDs). The analyzed outcomes were stone-free rate (SFR), blood loss, pain assessment, operative time, hospital stay and complications. We identified 8 trials with a total 749 patients. 353 patients were treated with MPCNL and 396 with PCNL. Meta-analysis of the data showed that there was no difference in SFR between MPCNL and PCNL (OR 1.06, 95 % CI 0.71–1.58). Patients in the MPCNL group experienced less drop in hemoglobin (MD: −4.67 g/L, 95 % CI −7.29 to −2.04), a lower incidence of blood transfusion (OR 0.18, 95 % CI 0.06–0.54), less pain (visual analog score) (MD: −0.53, 95 % CI −0.94 to −0.13) and shorter hospitalization (MD: −1.32 days, 95 % CI −2.15 to −0.50). Operative time was longer in the MPCNL group (MD: 15.54 min, 95 % CI 4.25–26.83). Postoperative fever and pyelocalyceal perforation did not differ between the groups (p = 0.38 and 0.44, respectively). Current evidence suggested that MPCNL was a safe and effective procedure with an SFR comparable to that of PCNL. MPCNL resulted in less bleeding, fewer transfusion, less pain and shorter hospitalization. Well-designed multicentric/international randomized, controlled trials are still needed.

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Acknowledgments

This work was financed by a Grant from National Natural Science Foundation, China (No. 81370804), Colleges and universities in Guangzhou Yangcheng scholars research project (No. 12A017S), and Science and technology project in Guangzhou (the people’s livelihood special major science and Technology) (No. 201300000096). The authors thank Professor Shaw P. Wan and Jody for improving the use of English in the manuscript.

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Authors and Affiliations

  1. Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

    Wei Zhu, Yang Liu, Luhao Liu, Ming Lei, Jian Yuan, Shaw P. Wan & Guohua Zeng

  2. Guangdong Key Laboratory of Urology, Kangda Road 1#, Haizhu District, Guangzhou, 510230, Guangdong, China

    Wei Zhu, Yang Liu, Luhao Liu, Ming Lei, Jian Yuan, Shaw P. Wan & Guohua Zeng

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  1. Wei Zhu
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  2. Yang Liu
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  3. Luhao Liu
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  4. Ming Lei
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  5. Jian Yuan
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  6. Shaw P. Wan
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  7. Guohua Zeng
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Correspondence to Guohua Zeng.

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Zhu, W., Liu, Y., Liu, L. et al. Minimally invasive versus standard percutaneous nephrolithotomy: a meta-analysis. Urolithiasis 43, 563–570 (2015). https://doi.org/10.1007/s00240-015-0808-y

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