Minimally Invasive Percutaneous Nephrolithotomy Versus Standard Percutaneous Nephrolithotomy In Treatment Of Upper Urinary Calculus:a Meta-analysis

Objective:To evaluate the safety and efficacy of minimally invasive percutaneous nephrolithotomy(MPCNL)and Standard percutaneous nephrolithotomy(SPCNL)in management of upper urinary calculus.Methods:Relevant randomized controlled trials studies were identified from electronic database Embase、The Cochrane Library、Pub Med、CNKI and Wangfang.The retrieval time span was from Jan 2000 inception to Nov 2018.The studies were screened according to the inclusion and exclusion criteria,the date were extracted and the quality was evaluated by 2 reviewers independently.And than the Meta-analysis was conducted using Rev Man 5.3 software.Results:A total of 18 studies were included,and 2375 cases were involved.In comparison with SPCNL,MPCNL showed significantly higher stone clearance in the treatment of Multiple caliceal stones[OR=1.64,95%CI(1.02,2.63),P=0.04],but there was no significant difference between the two groups in the treatment of Simple renal pelvis stones and staghorn stones(P>0.05);MPCNL showed significantly longer operation time in the treatment of Simple renal pelvis stones[MD=15.62,95%CI(12.95,18.30),P<0.00001],Multiple caliceal stones[MD=9.79,95%CI(7.12,12.47),P<0.00001]and staghorn stones[MD=20.65,95%CI(13.14,28.15),P<0.00001]compared with SPCNL.In the treatment of overall upper urinary calculus,MPCNL was better than SPCNL in the decrease of baemoglobin levels[MD=-0.04,95%CI(-0.16,0.09),P=0.56],hospitalstay time[MD=-0.96,95%CI(-1.51,-0.41),P=0.0006],transfusion[OR=0.23,95%CI(0.12,0.42),P<0.00001],There was no significant difference between two groups in fever,pain scores,urine leakage,Urinary sepsis and general complications(P>0.05).Conclusion:In the treatment of the upper urinary tract calculi,The advantages of MPCNLare reflected in the less intraoperative bleeding and postoperative blood transfusion,shorter hospital stay,higher stone clearance rate in the treatment of Multiple caliceal stones,but the operation time is longer than SPCNL.