Guglielmo Mantica1,2, Federica Balzarini3, Francesco Chierigo1, Etienne X Keller4,5, Michele Talso5,6, Esteban Emiliani5,7, Amelia Pietropaolo5,8, Rocco Papalia9, Roberto M Scarpa9, Carlo Terrone1, Francesco Esperto2,5,9. 1. Department of Urology, IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy. 2. European Society of Residents in Urology - ESRU, Arnhem, the Netherlands. 3. Department of Urology, IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy - balzarini.federica90@gmail.com. 4. Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 5. Young Academic Urologists - YAU, Urolithiasis and Endourology Working Party, Arnhem, the Netherlands. 6. Department of Urology, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy. 7. Unit of Endourology and Urolithiasis, Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain. 8. Department of Urology, University Hospital of Southampton, Southampton, UK. 9. Department of Urology, Campus Bio-Medico University, Rome, Italy.
Abstract
INTRODUCTION: The aim of this systematic review and meta-analysis was to provide an updated comparison between the currently available minimally invasive approaches (PCNL, laparoscopic [LP] and robotic pyelolithotomy [RP]) for the management of large renal stones. EVIDENCE ACQUISITION: An electronic search of the current literature was conducted through the Medline and NCBI PubMed, Embase, Scopus and Cochrane Collaboration Central Register of Controlled Clinical Trials databases in March 2021. Studies about minimally-invasive treatment for kidney stones were considered. Inclusion criteria were: studies evaluating patients with large renal calculi (≥2 cm); the comparison of at least two of the three approaches (PCNL, LP, RP), and reporting data suitable for meta-analysis evaluation. Patients with concomitant management for ureteropelvic junction obstruction (UPJ-O) were excluded. EVIDENCE SYNTHESIS: Overall, 17 reports were considered for qualitative and quantitative synthesis, for a total cohort of 1079 patients, of which 534 with PCNL, 525 treated with LP, and 20 with RP. Of those, 16 compared PCNL with LP, while only 1 study compared LP with RP. PCNL mean operative time was statistically significantly shorter than LP and RP while mean estimated blood loss was statistically significantly higher for PNCL. No statistically significant differences were recorded among the three surgical approaches. Finally, PCNL demonstrated slightly, albeit statistically significant lower stone free rate when compared with LP. CONCLUSIONS: PCNL, LP and RP may be safely and efficiently used to manage large renal stones. All three procedures showed reasonably low rate of complications with a satisfactory stone clearance rate.
INTRODUCTION: The aim of this systematic review and meta-analysis was to provide an updated comparison between the currently available minimally invasive approaches (PCNL, laparoscopic [LP] and robotic pyelolithotomy [RP]) for the management of large renal stones. EVIDENCE ACQUISITION: An electronic search of the current literature was conducted through the Medline and NCBI PubMed, Embase, Scopus and Cochrane Collaboration Central Register of Controlled Clinical Trials databases in March 2021. Studies about minimally-invasive treatment for kidney stones were considered. Inclusion criteria were: studies evaluating patients with large renal calculi (≥2 cm); the comparison of at least two of the three approaches (PCNL, LP, RP), and reporting data suitable for meta-analysis evaluation. Patients with concomitant management for ureteropelvic junction obstruction (UPJ-O) were excluded. EVIDENCE SYNTHESIS: Overall, 17 reports were considered for qualitative and quantitative synthesis, for a total cohort of 1079 patients, of which 534 with PCNL, 525 treated with LP, and 20 with RP. Of those, 16 compared PCNL with LP, while only 1 study compared LP with RP. PCNL mean operative time was statistically significantly shorter than LP and RP while mean estimated blood loss was statistically significantly higher for PNCL. No statistically significant differences were recorded among the three surgical approaches. Finally, PCNL demonstrated slightly, albeit statistically significant lower stone free rate when compared with LP. CONCLUSIONS: PCNL, LP and RP may be safely and efficiently used to manage large renal stones. All three procedures showed reasonably low rate of complications with a satisfactory stone clearance rate.