The comparison of synchronous bilateral and unilateral percutaneous nephrolithotomy: Meta-analysis

The objective of this meta-analysis was to evaluate the efficacy and safety of synchronous bilateral PCNL (B-PCNL) compared with staged unilateral PCNL (U-PCNL) in patients with bilateral kidney stones.

This analysis was conducted in accordance with the PRISMA guidelines and was registered with PROSPERO (CRD420251036639). The study population comprised adult patients (≥18 years) diagnosed with bilateral nephrolithiasis and treated using B-PCNL or U-PCNL. The primary outcomes were stone-free rate (SFR) and complication rates (Clavien-Dindo). A literature search was performed using the PubMed, Web of Science, and Scopus databases for studies published between 1996 and 2024. Meta-analysis was performed using a random-effects model. Statistical analyses were conducted using IBM SPSS Statistics (Version 29), and a p-value <0.05 was considered statistically significant.

Seven studies met the final inclusion criteria, with 5 retrospective cohort studies, 1 prospective cohort study, and 1 prospective randomized controlled trial. Egger's regression test (intercept = -0.61, p = 0.76) and Begg's rank correlation test (τ = 0.00, p = 1.00) revealed no significant evidence of publication bias. The overall log odds ratio for achieving SFR favoured the U-PCNL group, with an estimated log OR = -0.38 (95% CI: from -0.87 to 0.10; p = 0.12), although this difference did not reach statistical significance. There was no statistically significant difference for high-grade complications; the log odds ratio was 0.03 (95% CI: from -0.57 to 0.63, p = 0.91).

Based on low-certainty evidence, synchronous B-PCNL may be considered a selective option at experienced centres.