Alzahrani Meshari A, Alghuyaythat Waleed Khalid Z, Alsaadoon Bandar Mohammed B, Aldahash Abdullah Othman A, Alghamdi Abdulmohsen Khalid M, Alshammary Faisal Majid S, Alhodairy Muteb Saeed M, Alanazi Abdulaziz Mfwad A, Alotaibi Bader Qasi, Silsilah Mohammad Abdullah H, Alotibi Abdullah Naser A, Alhusini Faisal Khalid I, Alanazi Talal Mohammed A
Department of Urology, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia.
College of Medicine, Majmaah University, Majmaah, Saudi Arabia.
Transl Androl Urol. 2024 Jul 31;13(7):1127-1144. doi: 10.21037/tau-23-676. Epub 2024 Jul 16.
Prior research has assessed a range of surgical treatments for pediatric urolithiasis, emphasizing the necessity of tailor-made therapeutic approaches. These studies also show the adaptability of percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and shock wave lithotripsy (SWL) in managing diverse stone dimensions. The goal of this research was to examine the effectiveness of these varying surgical methods in treating pediatric urolithiasis.
Seven digital databases were explored to gather pertinent studies, following the guidelines established by the PRISMA protocol. The retrieved studies were subsequently scrutinized to draw comparisons between the stone-free rate (SFR) and the rate of complications associated with PCNL, RIRS, and SWL.
The SFR evaluation revealed no notable disparity between PCNL and RIRS [odds ratio (OR) 1.43, 95% confidence interval (CI): 0.67-3.05, P=0.36]. However, it was observed that both PCNL and RIRS outperformed SWL in terms of effectiveness (OR 2.51, 95% CI: 1.19-5.29, P=0.02 and OR 2.42, 95% CI: 1.41-4.14, P=0.001 respectively). Regarding the complication rates, no significant differences were observed among the three surgical methods (OR 0.67, 95% CI: 0.49-1.59, P=0.05), albeit with various forms of complications being reported. Certain studies associated PCNL with an elevated rate of complications, specifically urinary tract infections (UTIs) and severe hematuria.
Though PCNL and RIRS demonstrated higher effectiveness than SWL in achieving SFR, there was no significant disparity in the rates of complications across all three procedures. The study underscores the significance of personalized treatment plans, taking into account aspects such as the dimension and location of the stone, along with patient-specific characteristics.
先前的研究评估了一系列针对小儿尿石症的外科治疗方法，强调了量身定制治疗方法的必要性。这些研究还显示了经皮肾镜取石术（PCNL）、逆行肾内手术（RIRS）和冲击波碎石术（SWL）在处理不同大小结石方面的适应性。本研究的目的是检验这些不同手术方法治疗小儿尿石症的有效性。
按照PRISMA方案制定的指南，检索了七个数字数据库以收集相关研究。随后对检索到的研究进行审查，以比较无石率（SFR）以及与PCNL、RIRS和SWL相关的并发症发生率。
SFR评估显示PCNL和RIRS之间无显著差异[优势比（OR）1.43，95%置信区间（CI）：0.67 - 3.05，P = 0.36]。然而，观察到PCNL和RIRS在有效性方面均优于SWL（分别为OR 2.51，95% CI：1.19 - 5.29，P = 0.02和OR 2.42，95% CI：1.41 - 4.14，P = 0.001）。关于并发症发生率，三种手术方法之间未观察到显著差异（OR 0.67，95% CI：0.49 - 1.59，P = 0.05），尽管报告了各种形式的并发症。某些研究将PCNL与较高的并发症发生率相关联，特别是尿路感染（UTIs）和严重血尿。
尽管PCNL和RIRS在实现SFR方面显示出比SWL更高的有效性，但所有三种手术的并发症发生率无显著差异。该研究强调了个性化治疗计划的重要性，需考虑结石的大小和位置等因素以及患者的特定特征。
