Mini nephrolithotomy tied to high stone-free rates, more complications for urinary stone treatment
Minimally invasive percutaneous nephrolithotomy (mini-PCNL) provided a substantially higher stone-free rate (SFR) for upper renal calculi management compared with retrograde intrarenal surgery (RIRS), according to a meta-analysis. However, mini-PCNL also entailed a higher incidence of postoperative complications.
In an analysis of 13 trials involving 1,317 patients (n=701 and 616 mini-PCNL and RIRS cases, respectively), compared with the RIRS group, SFR was higher in the mini-PCNL group (odds ratio [OR], 1.96, 95 percent confidence interval [CI], 1.46–2.64; p<0.00001). [Biomed Res Int 2017;doi:10.1155/2017/2035851]
In a subgroup analysis based on stone location and size, mini-PCNL had a significantly higher SFR in any location (OR, 2.13, 95 percent CI, 1.53–2.96; p<0.00001) and resulted in a higher stone clearance in both 1–2 cm (OR, 2.01, 95 percent CI, 1.27–3.19; p=0.003) and >2 cm subgroups (OR, 4.73, 95 percent CI, 2.36–9.47; p<0.0001) compared with RIRS.
There was a larger postoperative decrease in haemoglobin levels (weighted mean difference [WMD], 0.60, 95 percent CI, 0.32–0.88; p<0.0001), longer hospital stay (WMD, 1.63 days, 95 percent CI, 0.98–2.28; p<0.00001), and higher complication rates in the mini-PCNL vs RIRS group (OR, 1.62, 95 percent CI, 0.92–2.88; p=0.10), which was further validated using the Clavien-Dindo Classification (OR, 1.63, 95 percent CI, 1.01–2.63; p=0.04 for grade II complications).
“[F]or grade II complications, mini-PCNL has a significantly higher rate than RIRS … which means RIRS was probably safer with respect to middle or severe morbidities after operation,” said the researchers.
Nonetheless, despite the drawbacks that might compromise its efficacy, mini-PCNL trumped RIRS with the remarkable SFR advantage, which is considered the primary parameter for evaluating both minimally invasive approaches, they said.
“[W]ith the development of the ‘mini-PCNL’ procedure, smaller access sheaths … are becoming increasingly popular for [their] relative safety,” said the researchers, highlighting the reduced postoperative morbidity such as blood loss and probable renal damage associated with minimally invasive alternatives.
Furthermore, although both mini-PCNL and RIRS are generally safe and effective alternatives for renal calculi management, both the American Urological Association and European Association of Urology guidelines favour PCNL for treating stones greater than 2 cm, noted the researchers.
Overall, the results were relatively stable, said the researchers, adding that the findings may help urologists with their clinical assessments for renal stone management.