Minimally invasive versus standard percutaneous nephrolithotomy: a meta-analysis

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrolithotomy

Background:

• Percutaneous nephrolithotomy (PCNL) is a standard treatment for kidney stones.
• Minimally invasive percutaneous nephrolithotomy (MPCNL) aims to improve outcomes over standard PCNL.
• Objective comparison of MPCNL and PCNL outcomes is needed.

Purpose of the Study:

• To systematically review and meta-analyze published data comparing outcomes of MPCNL versus PCNL.
• To objectively assess stone-free rates, complications, and patient recovery between the two procedures.

Main Methods:

• Systematic literature review conducted in November 2014 using PUBMED, EMBASE, and Cochrane Library databases.
• Inclusion of comparative studies (MPCNL vs. PCNL) only.
• Meta-analysis of effect sizes using pooled odds ratios (ORs) and mean differences (MDs) for stone-free rate (SFR), blood loss, pain, operative time, hospital stay, and complications.

Main Results:

• Eight trials involving 749 patients (353 MPCNL, 396 PCNL) were analyzed.
• No significant difference in stone-free rate (SFR) between MPCNL and PCNL (OR 1.06).
• MPCNL group showed significantly less hemoglobin drop (MD: -4.67 g/L), lower transfusion rates (OR 0.18), reduced pain (MD: -0.53), and shorter hospitalization (MD: -1.32 days).
• Operative time was longer for MPCNL (MD: 15.54 min).
• No difference in postoperative fever or pyelocalyceal perforation.

Conclusions:

• MPCNL is a safe and effective alternative to PCNL for kidney stone treatment.
• MPCNL offers significant advantages including reduced bleeding, transfusion needs, pain, and shorter hospital stays.
• Further well-designed, multicentric randomized controlled trials are recommended to confirm these findings.