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Super-Mini Percutaneous Nephrolithotomy for Nephrolithiasis: A Systematic Review and Meta-Analysis
Mohamed Zeid1, Hani Sayedin2, Natrajan Sridharan3,4
1Urology, University Hospital Limerick, Limerick, IRL.
Cureus
|January 9, 2023
Summary
Super-mini percutaneous nephrolithotomy (SMP) is a safe and effective treatment for kidney stones, showing comparable stone-free rates to mini-percutaneous nephrolithotomy (PCNL) and flexible ureteroscopy. SMP demonstrated a higher stone-free rate than retrograde intrarenal surgery.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Nephrolithiasis Management
Background:
- Renal stones pose a significant health burden, necessitating effective treatment options.
- Percutaneous nephrolithotomy (PCNL) techniques have evolved, with mini-PCNL and super-mini PCNL (SMP) offering less invasive approaches.
- Comparative data on the efficacy and safety of SMP versus other minimally invasive renal stone treatments are crucial for clinical decision-making.
Purpose of the Study:
- To systematically review and meta-analyze the existing evidence on super-mini percutaneous nephrolithotomy (SMP) for renal stone treatment.
- To compare the outcomes of SMP with standard mini-percutaneous nephrolithotomy (PCNL) and other endourological procedures.
- To evaluate the stone-free rate, operative time, and postoperative complications associated with SMP.
Main Methods:
- A systematic literature search was performed on Medline (PubMed) and SCOPUS databases until May 2022.
- Included studies were screened for eligibility, and data were extracted by two independent reviewers.
- Meta-analyses were conducted using Open Meta-Analyst and Review Manager 5.4, including risk of bias assessment.
Main Results:
- Fourteen studies involving 4,323 patients were included in the meta-analysis.
- SMP achieved a stone-free rate (SFR) of 91.4%, with no significant difference compared to mini-PCNL (MD = 1.03, p = 0.12) and flexible ureteroscopy (MD = 0.84, p = 0.65).
- SMP showed a significantly better SFR than retrograde intrarenal surgery (MD = 1.3, p = 0.04), but had a longer operative time than mini-PCNL (MD = 1.92, p < 0.001) and shorter than ureteroscopy (MD = -17.17, p < 0.00001). Postoperative complications were low (fever 7.6%, pain 2.3%, hematuria 3.4%), with a mean hospital stay of 2.4 days.
Conclusions:
- Super-mini percutaneous nephrolithotomy (SMP) is a safe and effective minimally invasive treatment for renal stones in both pediatric and adult populations.
- SMP offers comparable stone-free rates to established mini-PCNL and flexible ureteroscopy techniques.
- The findings support the consideration of SMP as a valuable option in the armamentarium for managing kidney stones.
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