Ramez Mohamed, Desoky Esam A E, El-Nahas Ahmed R
Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Arab J Urol. 2024 Jun 3;22(4):253-260. doi: 10.1080/20905998.2024.2362462. eCollection 2024.
Percutaneous nephrolithotomy (PCNL) is the treatment of choice for pediatric nephrolithiasis more than 20 mm. Prone position was the preferred position for decades. Recently, supine position has gained more interest. This meta-analysis aims to evaluate the safety and efficacy of PCNL in supine versus prone position in pediatric population. A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library was performed till 28 February 2024. The study included comparative studies comparing both positions in children that were written in English. A total of three randomized studies and three retrospective studies were included with a total number of 290 patients. Cochrane risk-of-bias tool for randomized trials was used for quality assessment, while Newcastle-Ottawa scale was used for non-randomized controlled trials. The meta-analysis was conducted using Review Manager software. Numerical data were analyzed using standardized mean difference (SMD), while the risk ratio was used for analysis of categorical data. Fixed or random effects models were used according to heterogeneity. There were statistically insignificant differences between both groups for stone-free rate (RR 1.08, 95% CI [0.98-1.18], = 0.11) and overall complications (RR 0.93, 95% CI [0.59-1.47], = 0.76). Operation time was significantly shorter in supine group (SMD -0.99, 95% CI [-1.67 to -0.30], = 0.005). Therefore, comparable efficacy and safety outcomes were proved between both supine and prone positions for PCNL in pediatrics.
经皮肾镜取石术（PCNL）是治疗直径超过20毫米的小儿肾结石的首选方法。几十年来，俯卧位一直是首选体位。最近，仰卧位受到了更多关注。这项荟萃分析旨在评估小儿患者中仰卧位与俯卧位PCNL的安全性和有效性。截至2024年2月28日，对PubMed、Scopus、Web of Science和Cochrane图书馆进行了系统检索。该研究纳入了用英文撰写的比较儿童两种体位的对照研究。总共纳入了三项随机研究和三项回顾性研究，共有290例患者。随机试验采用Cochrane偏倚风险工具进行质量评估，而非随机对照试验采用纽卡斯尔-渥太华量表。使用Review Manager软件进行荟萃分析。数值数据采用标准化均数差（SMD）进行分析，分类数据采用风险比进行分析。根据异质性采用固定效应或随机效应模型。两组在结石清除率（RR 1.08，95%CI[0.98 - 1.18]， = 0.11）和总体并发症（RR 0.93，95%CI[0.59 - 1.47]， = 0.76）方面无统计学显著差异。仰卧位组的手术时间明显更短（SMD -0.99，95%CI[-1.67至-0.30]， = 0.005）。因此，小儿PCNL的仰卧位和俯卧位在疗效和安全性方面具有可比性。
