Percutaneous nephrolithotomy versus retrograde intrarenal surgery on mid-sized lower calyx stones- a systematic review of last decade

BackgroundTo systematically assess the effectiveness and safety of retrograde intrarenal surgery (RIRS) versus percutaneous nephrolithotomy (PCNL) in treating lower pole stones.MethodsPubMed, Ovid MEDLINE, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE were researched to identify relevant studies up to May 2018. Based on keyword searches, we explored 1972 studies; following screening and eligibility evaluation, 414 studies were removed for various reasons, including 11 possibly relevant studies for this systematic review. A total of 1342 patient data were interpreted (PCNLn = 688; RIRS n = 654).ResultsThe stone-free rate (SFR) in ten studies following the PCNL operation varies from 68 to 98.3%, while after the RIRS procedure, it ranges from around 46-93.7%. Out of 10 investigations, 7 demonstrated a superior SFR for the PCNL technique compared to the RIRS. Of the ten investigations, eight demonstrated reduced surgical durations using the PCNL method compared to the RIRS procedure. The duration of hospital stays for the PCNL treatment varies from around 0.3 +/- 0.04 to 5.3 +/- 1.20 days, while the duration for RIRS procedures ranges from 0 to 3.2 +/- 0.52 days. All nine trials indicated a reduced period of hospital stay with the RIRS technique compared to the PCNL procedure. The complication rates in 10 studies following the PCNL surgery varied from approximately 2-72%, while those after the RIRS procedure ranged from about 4-21.6%. Out of 10 trials, 6 demonstrated a reduced complication rate with the RIRS technique compared to the PCNL.ConclusionThe majority of studies in this systematic review indicate that the PCNL method exhibits a superior SFR, reduced operational duration, prolonged hospital stay, and increased complication rates compared to the RIRS procedure.Clinical trial numberNot applicable, as this is a systematic review.