Yu-Hsiang Yang1,2, Yu-Ching Wen3,4, Kuan-Chou Chen5,6, Chiehfeng Chen7,8,9,10. 1. School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 2. Department of Medical education, Linkou Chang Gung Memorial Hospital, Taoyuan District, Taoyuan, Taiwan. 3. Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 4. Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. 5. Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 6. Department of Urology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. 7. Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, 250 Wuxing St., Taipei, 11031, Taiwan, ROC. clifchen@tmu.edu.tw. 8. Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan. clifchen@tmu.edu.tw. 9. Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. clifchen@tmu.edu.tw. 10. Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. clifchen@tmu.edu.tw.
Abstract
PURPOSE: To evaluate the efficacy and safety of ultrasound-guided (UG) versus fluoroscopy-guided (FG) percutaneous nephrolithotomy (PCNL). METHODS: A systematic search of PubMed (MEDLINE), Embase, and the Cochrane Library was conducted to identify randomized controlled trials that compared UG-PCNL with FG-PCNL, and a meta-analysis of those studies was completed. The primary outcomes assessed were stone-free rate (SFR) and complication rate. Secondary outcomes assessed were the successful access-creation rate, time necessary for entrance into the target calyx, auxiliary procedure rate, transfusion rate, hemoglobin decrease after surgery, surgery duration, and hospital stay. RESULTS: Eight studies comprising 966 patients were included in the meta-analysis. Compared with FG-PCNL, UG-PCNL had comparable stone-free rates [odds ratio (OR) 0.95; 95% confidence interval (CI) 0.67-1.35; p = 0.79] irrespective of the patient's position, and a favorable safety profile resulting in a lower complication rate (OR 0.56; 95% CI 0.36-0.86; p = 0.009). No statistical difference was found between UG and FG groups in secondary outcomes. CONCLUSIONS: UG-PCNL is as effective as FG-PCNL and has the advantage of lower complication rates. In addition, UG-PCNL could be performed with patients in the supine position without compromising its efficacy.
PURPOSE: To evaluate the efficacy and safety of ultrasound-guided (UG) versus fluoroscopy-guided (FG) percutaneous nephrolithotomy (PCNL). METHODS: A systematic search of PubMed (MEDLINE), Embase, and the Cochrane Library was conducted to identify randomized controlled trials that compared UG-PCNL with FG-PCNL, and a meta-analysis of those studies was completed. The primary outcomes assessed were stone-free rate (SFR) and complication rate. Secondary outcomes assessed were the successful access-creation rate, time necessary for entrance into the target calyx, auxiliary procedure rate, transfusion rate, hemoglobin decrease after surgery, surgery duration, and hospital stay. RESULTS: Eight studies comprising 966 patients were included in the meta-analysis. Compared with FG-PCNL, UG-PCNL had comparable stone-free rates [odds ratio (OR) 0.95; 95% confidence interval (CI) 0.67-1.35; p = 0.79] irrespective of the patient's position, and a favorable safety profile resulting in a lower complication rate (OR 0.56; 95% CI 0.36-0.86; p = 0.009). No statistical difference was found between UG and FG groups in secondary outcomes. CONCLUSIONS: UG-PCNL is as effective as FG-PCNL and has the advantage of lower complication rates. In addition, UG-PCNL could be performed with patients in the supine position without compromising its efficacy.
Authors: Darren Beiko; Hassan Razvi; Naeem Bhojani; Jennifer Bjazevic; David B Bayne; David T Tzou; Marshall L Stoller; Thomas Chi Journal: Can Urol Assoc J Date: 2019-09-27 Impact factor: 1.862