Management of large renal stones: laparoscopic pyelolithotomy versus percutaneous nephrolithotomy

Percutaneous nephrolithotomy (PCNL) remains the standard procedure for large (≥2 cm) renal calculi; however, laparoscopic pyelolithotomy (LPL) can be used as an alternative management procedure. The aim of present study was to compare LPL and PCNL in terms of efficacy and safety for the management of large renal pelvic stones.

A literature search was performed in Jan 2016 using electronic databases (Cochrane Central Register of Controlled Trials, Medline, and EMBASE) to identify relevant studies for the meta-analysis. Only comparative studies investigating LPL versus PCNL were included. Effect sizes were estimated by pooled odds ratio (ORs) and mean differences (MDs) with 95% confidence intervals (CIs).

Five randomized and nine non-randomized studies were identified for analysis, involving a total of 901 patients. Compared with PCNL, LPL provided a significantly higher stone-free rate (OR 3.94, 95% CI 2.06-7.55, P < 0.001), lower blood transfusion rate (OR 0.28, 95% CI 0.13-0.61, P = 0.001), lower bleeding rate (OR 0.20, 95% CI 0.06-0.61, P = 0.005), fewer hemoglobin decrease(MD -0.80, 95% CI -0.97 to -0.63, P < 0.001), less postoperative fever (OR 0.38, 95% CI 0.21-0.68; P = 0.001), and lower auxiliary procedure rate (OR 0.24, 95% CI 0.12-0.46, P < 0.001) and re-treatment rate (OR 0.20, 95% CI 0.07-0.55, P = 0.002). However, LPL had a longer operative time and hospital stay. There were no significant differences in conversion to open surgery and prolonged urine leakage rates between LPL and PCNL.

Our present findings suggest that LPL is a safe and effective approach for management of patients with large renal stones. However, PCNL still suitable for most cases and LPL can be used as an alternative management procedure with good selection of cases.