Endourological Management of Renal Stones: A Systematic Review, Bayesian Network Meta-analysis and Meta-regression

Area of Science:

• Urology
• Endourology
• Nephrolithiasis Management

Background:

• Kidney stone management involves various endoscopic techniques.
• Optimizing stone-free rates (SFRs) and operative efficiency is crucial.

Purpose of the Study:

• To compare the stone-free rates (SFRs), operative times, and transfusion rates of different endoscopic techniques for kidney stone management.
• To evaluate the efficacy of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for various stone burdens.

Main Methods:

• A systematic review and Bayesian network meta-analysis were conducted.
• Studies were categorized by stone location (lower pole) and size (1-2cm, >2cm).
• Odds ratios (OR) with 95% credible intervals were reported to compare techniques.

Main Results:

• For lower pole stones, PCNL and mini-PCNL demonstrated significantly higher SFRs than RIRS.
• For stones >2cm, PCNL, mini-PCNL, and ultramini-PCNL achieved superior SFRs compared to RIRS.
• For 1-2cm stones, mini-PCNL showed improved SFRs over RIRS, but other percutaneous methods did not show significant differences.

Conclusions:

• Percutaneous approaches, particularly PCNL and mini-PCNL, are more effective for lower pole and large kidney stones (>2cm) than RIRS.
• For 1-2cm stones, mini-PCNL offers an advantage, while other percutaneous techniques show comparable SFRs to RIRS.
• Micro-PCNL did not demonstrate superior stone clearance for lower pole stones compared to RIRS.