Dorantes-Carrillo Luis Alberto, Basulto-Martínez Mario, Suárez-Ibarrola Rodrigo, Heinze Alexander, Proietti Silvia, Flores-Tapia Juan Pablo, Esqueda-Mendoza Antonio, Giusti Guido
School of Medicine, Universidad Autónoma de Yucatán, Merida, Mexico.
European Training Center in Endourology, Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy; Department of Urology, Hospital Regional de Alta Especialidad de la Península de Yucatán, Merida, Mexico.
Eur Urol Focus. 2022 Jan;8(1):259-270. doi: 10.1016/j.euf.2021.02.008. Epub 2021 Feb 21.
Although miniaturized percutaneous nephrolithotomy (mPCNL) and retrograde intrarenal surgery (RIRS) are both options for treating >1cm kidney stones, controversies exist on whether one is more effective and safer than the other.
To systematically appraise randomized trials comparing the effectiveness and safety of mPCNL and RIRS for treating >1cm kidney stones.
A systematic search on PubMed/Medline, Web of Science, Embase, and ClinicalTrials.gov was conducted in August 2020 following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA). Randomized trials comparing mPCNL and RIRS for >1cm kidney stones, and reporting stone-free rate (SFR), hemoglobin drop, transfusion rate, length of hospital stay (LOS), and/or complications, were included.
Eight studies compared mPCNL and RIRS, but one was not included due to its high risk of bias. SFR was higher for mPCNL (RR: 1.06 [95% coefficient interval {CI}, 1.01-1.10], p=0.008). Hemoglobin drop was higher for mPCNL (mean difference [MD]: 0.35 [95% CI, 0.05-0.65] g/dl, p=0.02); however, transfusion rates were similar (p=0.44). Complication rate was similar between mPCNL and RIRS (p=0.39), and the LOS was higher for mPCNL (MD: 1.11 [95% CI, 0.06-2.16] d, p=0.04). A subgroup analysis of lower pole stones showed that SFR was higher for mPCNL (RR: 1.09 [95% CI, 1.00-1.19], p=0.05).
Both approaches are effective and safe. Among these approaches, mPCNL has a higher SFR than RIRS for overall >1cm renal and lower pole stones, but longer LOS, and a higher hemoglobin drop that does not translate into higher transfusion rates. Complications are comparable.
Randomized trials have evaluated whether miniaturized percutaneous nephrolithotomy (mPCNL) or retrograde intrarenal surgery is more effective and safer for treating >1cm stones. After comparing the stone-free rate, hemoglobin drop, transfusion rate, length of hospital stay, and complications between both the approaches, mPCNL was found to be slightly more effective, but both were equally safe.
尽管微创经皮肾镜取石术（mPCNL）和逆行肾内手术（RIRS）都是治疗直径大于1cm肾结石的选择，但对于哪种方法更有效、更安全仍存在争议。
系统评价比较mPCNL和RIRS治疗直径大于1cm肾结石有效性和安全性的随机试验。
2020年8月，按照系统评价和Meta分析的首选报告项目（PRISMA），在PubMed/Medline、科学网、Embase和ClinicalTrials.gov上进行了系统检索。纳入比较mPCNL和RIRS治疗直径大于1cm肾结石，并报告结石清除率（SFR）、血红蛋白下降、输血率、住院时间（LOS）和/或并发症的随机试验。
八项研究比较了mPCNL和RIRS，但其中一项因偏倚风险高未纳入。mPCNL的SFR更高（相对危险度[RR]：1.06[95%可信区间{CI}，1.01-1.10]，p=0.008）。mPCNL的血红蛋白下降更高（平均差[MD]：0.35[95%CI，0.05-0.65]g/dl，p=0.02）；然而，输血率相似（p=0.44）。mPCNL和RIRS的并发症发生率相似（p=0.39），mPCNL的LOS更高（MD：1.11[95%CI，0.06-2.16]天，p=0.04）。下极结石的亚组分析显示，mPCNL的SFR更高（RR：1.09[95%CI，1.00-1.19]，p=0.05）。
两种方法均有效且安全。在这些方法中，对于总体直径大于1cm的肾和下极结石，mPCNL的SFR高于RIRS，但LOS更长，血红蛋白下降更高，但输血率并未更高。并发症相当。
随机试验评估了微创经皮肾镜取石术（mPCNL）或逆行肾内手术治疗直径大于1cm结石是否更有效、更安全。在比较两种方法的结石清除率、血红蛋白下降、输血率、住院时间和并发症后，发现mPCNL略更有效，但两者同样安全。
