Is It Safe to Increase the Number of Percutaneous Nephrolithotomy Channels: A Systematic Review and Meta-Analysis

Purpose: Percutaneous nephrolithotomy (PCNL) requires perforating the kidney, which may damage part of the patient's nephron. Further, compared with single-channel PCNL (S-PCNL), the safety of multi-channel PCNL (M-PCNL) and whether it affects the renal function of patients has been debated. The meta-analysis aimed to comprehensively evaluate the safety of M-PCNL.Methods: We carefully searched the Pubmed, Embass, and Web of Science databases for relevant research reported before Oc-tober 30, 2021, and analyzed the included literature using the Stata software. Changes in the serum creatinine levels, split renal function and the incidence of postoperative complications were used to evaluate the safety of M-PCNL.Results: Overall, 11 articles were included in this meta-analysis. The results showed that there was no statistically significant difference between S-PCNL and M-PCNL in terms of changes in serum creatinine levels (pooled Mean Difference (MD) = -0.015, 95% CI: -0.047-0.018, I2 = 0.0%, p = 0.92). Further, a sensitivity analysis showed that our conclusions were stable. With the p-values in both Egger's and Begg's tests being greater than 0.05, there was no significant publication bias in the included lit-erature. A subgroup analysis based on patient ethnicity yielded consistent results. Our meta-analysis yielded similar results in terms of changes in split renal function (pooled MD = 0.008, 95% CI: -0.013-0.030, I2 = 96%,p < 0.01). There was no significant difference in the incidence of postoperative renal perforation between M-PCNL and S-PCNL (pooled Odds Ratio (OR) = 1.686, 95% CI: 0.677-4.193, I2 = 0.0%,p = 0.66). However, M-PCNL was found to cause more postoperative blood transfusion, post-operative infection, and pleural damage than S-PCNL (pooled OR = 3.104, 95% CI: 2.277-4.232, I2 = 46%,p = 0.03, pooled OR = 1.862, 95% CI: 1.165-2.974, I2 = 0%,p = 0.46, and pooled OR = 3.446, 95% CI: 1.168-10.171, I2 = 0%,p = 1.00 respectively).Conclusions: Compared with S-PCNL, M-PCNL showed no significant differences in terms of changes in serum creatinine levels in patients. However, M-PCNL showed a greater probability of resulting in postoperative blood transfusion, postoperative infection, and pleural damage.