Safety and efficacy of percutaneous nephrolithotomy, retrograde intrarenal surgery, and extracorporeal shock wave lithotripsy for lower-pole renal stones: A systematic review and meta-analysis

Background:Numerous therapeutic strategies have been developed as a result of the rise in the prevalence of renal stones. Extracorporeal shock wave lithotripsy (ESWL) retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are currently available treatments for lower-pole renal stones (LPRSs). This systematic review and meta-main analysis's primary objective were to assess the requisite studies that examined the effectiveness of ESWL, RIRS, and PCNL for treating LPRS. Materials and Methods:This study adhered to PRISMA guidelines' guiding principles. In two stages, the desired studies were extracted. In the initial screening, we identified 850 related articles from the years 2004 to 2022 using the keywords. Unfortunately, 350 studies were disqualified because they failed to meet our inclusion requirements; the remaining studies underwent additional screening. In the second stage, two authors went through the entire text of the articles and found duplicates and missing data. Ten articles were eventually selected for the research's conclusion. Results:PCNL and RIRS had higher stone-free rates than ESWL and needed fewer treatment sessions out of the total of 10 clinical trials that were considered to be eligible. While ESWL required more ESWL sessions, operative time and complications seemed to benefit ESWL over PCNL. RIRS looked to be the most efficient technique for treating stones in the lower pole that were up to 1 cm in diameter. Conclusion:To achieve stone-free status over a brief period of time and with the fewest number of sessions, the management of LPRS should probably be PCNL or RIRS, according to the pooled meta-analysis of the eligible trials in our systematic review. RIRS was more effective than ESWL for stones <10 mm in size. The choice between the two methods (PCNL or RIRS) should be made specifically for each patient depending on their anatomical characteristics, comorbidities, and preferences as deemed appropriate by the attending clinician.