Ultrasound-guided versus fluoroscopy-guided percutaneous nephrolithotomy: a systematic review and meta-analysis

PurposeTo evaluate the efficacy and safety of ultrasound-guided (UG) versus fluoroscopy-guided (FG) percutaneous nephrolithotomy (PCNL).MethodsA systematic search of PubMed (MEDLINE), Embase, and the Cochrane Library was conducted to identify randomized controlled trials that compared UG-PCNL with FG-PCNL, and a meta-analysis of those studies was completed. The primary outcomes assessed were stone-free rate (SFR) and complication rate. Secondary outcomes assessed were the successful access-creation rate, time necessary for entrance into the target calyx, auxiliary procedure rate, transfusion rate, hemoglobin decrease after surgery, surgery duration, and hospital stay.ResultsEight studies comprising 966 patients were included in the meta-analysis. Compared with FG-PCNL, UG-PCNL had comparable stone-free rates [odds ratio (OR) 0.95; 95% confidence interval (CI) 0.67-1.35; p=0.79] irrespective of the patient's position, and a favorable safety profile resulting in a lower complication rate (OR 0.56; 95% CI 0.36-0.86; p=0.009). No statistical difference was found between UG and FG groups in secondary outcomes.ConclusionsUG-PCNL is as effective as FG-PCNL and has the advantage of lower complication rates. In addition, UG-PCNL could be performed with patients in the supine position without compromising its efficacy.