Comparison Of Percutaneous Nephrolithotomy Versus Retrograde Intrarenal Surgery For Kidney Stones In Patients With Solitary Kidney:A Meta-analysis

Objective To compare the efficacy and safety of percutaneous nephrolithotomy(PCNL)and retrograde intrarenal surgery(RIRS)in the treatment of kidney stones with solitary kidney.Methods We searched CNKI,Wanfang Database,VIP,PubMed,Embase and The Cochrane Library to identify relevant studies of clinical trials,which compared percutaneous nephrolithotomy(PCNL)and retrograde intrarenal surgery(RIRS)in the treatment of kidney stones with solitary kidney from January 2000 to January 2018.Two reviewers independently included the standard documents into the meta-analysis,evaluated the quality of the included studies,and extracted the data in the studies.The meta-analysis was performed with RevMan5.3 software.Results Ten studies were included,involving a total of 698 patients.Results of meta-analysis showed that in the PCNL group,the operation time(SMD =-0.71,95%CI:-1.19,-0.22,P=0.004),initial stone-free rate(OR = 2.66,95% CI: 1.76,2.03,P = 0.004),fever(OR = 0.42,95%CI: 0.24,0.74,P = 0.0003)were superior to those in the RIRS group.In contrast,the intraoperative hemorrhage(WMD = 76.29,95% CI: 42.22,110.36,P < 0.0001),postoperative bleeding(OR = 8.82,95% CI: 1.41,2.91,P = 0.004),postoperative hemoglobin decreased(SMD = 1.85,95% CI: 0.82,2.87,P = 0.0004),blood transfusion(SMD = 5.72,95% CI: 1.41,2.91,P <0.00001)was higher than that of the RIRS group.The PCNL group brought longer hospital stay(SMD=2.16,95%CI: 1.41,2.91,P < 0.00001).There were no statistically significant differences between PCNL and RIRS in the complications(OR = 1.28,95%CI: 0.78,2.10,P = 0.32),Clavien ?~? complications(OR = 1.50,95%CI: 0.90,2.50,P = 0.12),Clavien ?~? complications(OR = 0.36,95%CI: 0.08,1.59,P = 0.18),postoperative infection(OR = 0.54,95%CI: 0.08,3.77,P = 0.54),postoperative embolization(OR =3.37,95%CI: 0.55,20.49,P = 0.19),Steinstrasse(OR = 0.26,95% CI: 0.04,1.60,P = 0.15).There were no adjacent organ injuries in the PCNL group and the RIRS group,no open surgery,no nephrectomy,no hemodialysis treatment,and no deaths.Conclusions Both PCNL and RIRS are effective and safe for the treatment of kidney stones with solitary kidney.PCNL can get higher initial stone-free rate,higher fever rate and shorter operation time,while RIRS can get shorter hospitalization time and reduce bleeding rates in the perioperative period.However,further randomized controlled trials are needed to confirm these findings.