Mini-Endoscopic Combined Intrarenal Surgery(mini-ECIRS) Versus Minimally Percutaneous Nephrolithotomy For Staghorn Calculi:A Meta-analysis

Objective:To evaluation the clinical safety and efficacy of Single-Tract of Minimally Percutaneous Nephrolithotomy versus mini-endoscopic combined intrarenal surgery(mini-ECIRS)for staghorn calculi.Methods:Seven databases(PubMed、Embase、EMBASE、CNKI、VIP database)were comprehensively searched(publication dates ranging from library to 2018)with controlled clinical trial(RCT)or controlled clinical trials(CCT)that compared mini-ECIRS with control perioperative applied in staghorn calculi.strictly screening accordance to the standard,assessing the quality of these studies,data were extracted from these trials and analyzed by the Review Manager 5.3 software.Results:1.The baseline characteristics of the selected studies: seven observational studies with a total of 516 patients(250 in mini-ECIRS groups and 266 in MPCNL groups)were identified in our study.2.Comparison of one-step stone free rate(SFR)after operation in two groups : compare with MPCNL group,mini-ECIRS group had higher one-step SFR(OR=4.83,95%CI:3.16-7.49;P<0.00001).3.Comparison of mean operative time after operation in two groups:compare with MPCNL group,mini-ECIRS group had longer operative time(WMD=19.32,95%CI:14.56-24.08;P<0.0001).4.Comparison of blood loss after operation in two groups :compare with MPCNL group,mini-ECIRS group had lower blood loss(WMD=-12.13,95%CI:-15.81--11.90;P=0.0007).5.Comparison of hospitalization time after operation in two groups :compare with MPCNL group,mini-ECIRS group had lower hospitalization time(WMD=-1.23,95%CI:-2.33--0.12;P=0.03).6.Comparison of complication after operation in two groups:compare withMPCN group,mini-ECIRS group had lower severe complication(OR=0.32,95%CI:0.15-0.69;P=0.004).Conclusious:1.Mini-endoscopic combined intrarenal surgery with flexible ureteroscope(mini-ECIRS)for staghorn calculi is safety and efficacy,mini-ECIRS has high stone free rate(SFR)and less severe complication versus MPCNL.2.In conclusion,comparied with MPCNL mini-ECIRS for staghorn calculi is efficacy and safety,Because of bounded in our study,further multicenter controlled clinical trials are needed to provide theoretical support.