Minipercutaneous nephrolithotomy and retrograde intrarenal surgery in the treatment of kidney stones: a meta-analysis based on a systematic review of the literature

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Abstract

Mini-percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are increasingly used to treat kidney stones. There is still debate in the literature regarding the efficiency and safety of these surgical procedures.

Aim. To carry out a systematic review of the results of mini-PCNL and RIRS.

A search of publications in the PubMed, Scopus, and Web of Science databases for the past 10 years was carried out to identify all studies that compared the results of mini-PCNL and RIRS. The following parameters were assessed: number and age of patients, stone size, presence of a lower-pole stone, duration of the procedure, complications according to the Clavien-Dindo classification, efficiency of the procedure, and length of hospital stay.

A total of 21 publications with comparative analyze of various variables for mini-PCNL and RIRS for kidney stones larger than 10 mm were found. The difference in the duration of the procedure between mini-PCNL and RIRS was 2.34 min, in the length of hospital stay 1.62 days. The relative risk (RR) of developing complications according to Clavien-Dindo grades I-III during mini-PCNL compared to RIRS was 1.16 (95% CI 0.88-1.53, p=0.2929), and the probability of SFR was 1.08 (95% CI 1.05-1.12).

The analysis showed that RIRS is associated with a shorter duration of procedure and length of hospital stay compared to mini-PCNL. The results were statistically significant regardless of stone size. For stones larger than 15 mm, mini-PCNL provides a slight advantage in efficiency compared to RIRS, and for stones larger than 25 mm, mini-PCNL is more preferable than RIRS, although the results do not differ significantly.

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About the authors

Bahman G. Guliyev

FGBOU VO North-Western State Medical University named after I.I. Mechnikov; City Mariinsky hospital

Author for correspondence.
Email: gulievbg@mail.ru
ORCID iD: 0000-0002-2359-6973

Department of Urology, Ph.D., MD, professor, Head of Center of Urology with robot-assisted surgery

Russian Federation, 191014, Saint Petersburg, Liteiny pr., 56

Alexander A. Andrianov

FGBOU VO North-Western State Medical University named after I.I. Mechnikov

Email: mr.haisenberg001@gmail.com
ORCID iD: 0000-0001-6905-0581

resident at the Department of Urology 

Russian Federation, 195067, Saint Petersburg, Piskarevsky pr., 47

Murad U. Agagyulov

FGBOU VO North-Western State Medical University named after I.I. Mechnikov

Email: murad1311@bk.ru
ORCID iD: 0000-0003-2497-5040

Ph.D. student at the Department of Urology 

Russian Federation, 195067, Saint Petersburg, Piskarevsky pr., 47

Ali E. Talyshinsky

City Mariinsky hospital

Email: ali-ma@mail.ru
ORCID iD: 0000-0002-3521-8937

urologist at the Center of Urology with robot-assisted surgery

Russian Federation, 191014, Saint Petersburg, Liteiny pr., 56

Alexandra S Fundament

City Mariinsky hospital

Email: aleksander.bane@yandex.ru
ORCID iD: 0009-0003-3925-2504

urologist at the Center of Urology with robot-assisted surgery

Russian Federation, 191014, Saint Petersburg, Liteiny pr., 56

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Supplementary files

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2. Fig. 1. Multi-step process of selection and analysis of scientific publications for inclusion in a meta-analysis comparing mini-PNL and RIRS

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3. Fig. 2. Correlation matrix between quantitative variables

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4. Table 2. Results of the meta-analysis of the duration of surgical intervention depending on the stone size

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5. Table 3. Results of meta-analysis of the relative risk of developing complications of grades II-III according to Clavien-Dindo depending on the stone size

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6. Table 4. Results of meta-analysis of the relative risk of developing grade III complications according to Clavien-Dindo

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7. Fig. 3. Relative risk of developing complications of grade III according to Clavien-Dindo depending on the average stone size

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8. Table 5. Results of the meta-analysis of the relative risk of complete freedom from stone size

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9. Fig. 4. Linear model between the relative risk of stone-free status and the average stone size

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10. Table 6. Duration of hospitalization of patients after mini-PNL and RIRS

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