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A meta-analysis: retrograde intrarenal surgery vs. percutaneous nephrolithotomy in children

Yi Yuan1, Yan-Nei Liang1, Kai-Feng Li1

  • 1Department of Pediatric Urology Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China.

Frontiers in Pediatrics
|May 19, 2023
PubMed

Insights

Micro-percutaneous nephrolithotomy (micro-PCNL) shows superior outcomes for pediatric kidney stones compared to retrograde intrarenal surgery (RIRS), including higher stone-free rates and fewer complications. Further research is needed to fully illustrate efficacy.

Area of Science:

  • Pediatric Urology
  • Nephrolithiasis Management
  • Minimally Invasive Surgery

Background:

  • Pediatric kidney stones are increasing globally.
  • Minimally invasive lithotripsy, including retrograde intrarenal surgery (RIRS) and percutaneous Nephrolithotomy (PCNL), is frequently used.
  • The comparative safety and efficacy of RIRS and PCNL in children remain debated.

Purpose of the Study:

  • To conduct a meta-analysis comparing retrograde intrarenal surgery (RIRS) and percutaneous Nephrolithotomy (PCNL) for pediatric kidney stones.
  • To evaluate the safety and efficacy of micro-PCNL versus other minimally invasive techniques.

Main Methods:

  • A systematic literature search was performed across PubMed, EMBASE, Scopus, and Cochrane Library.
  • Data extraction and quality assessment were conducted independently by two reviewers.
  • Therapeutic effects were analyzed using Review Manager 5.4.

Main Results:

  • Thirteen studies with 1,019 pediatric patients were included.
  • Micro-PCNL demonstrated a significantly higher stone-free rate (P=0.003) and lower postoperative fever (P=0.02) and Clavien-Dindo II complications (P=0.05).
  • While operation time for mini-PCNL was longer than RIRS (P<0.00001), micro-PCNL showed a higher probability of Clavien-Dindo I and II complications than RIRS.

Conclusions:

  • Micro-PCNL may be a preferred therapeutic option for pediatric kidney stones over RIRS.
  • Further analysis of additional parameters is recommended due to limited case numbers in the study.
  • The study highlights the need for comprehensive data to fully assess minimally invasive surgery efficacy in pediatric nephrolithiasis.
Abstract

Keywords:
childkidney calculimeta-analysisnephrolithotomypercutaneousretrograde intrarenal surgery

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