Percutaneous Nephrolithotomy Versus Flexible Ureteroscopic Lithotripsy In The Treatment Of Upper Urinary Tract Stones: A Meta-analysis Comparing Clinical Efficacy And Safety Profil

ObjectiveThis study aim to comprehensively evaluate the different efficacy and safety in treating upper urinary tract stones between percutaneous nephrolithotomy(PCNL)and flexible ureteroscopic lithotripsy(fURL),and provide some reference for clinical work.MethodsA systematic search using domestic and foreign electronic database and supplemented by manual search and literature search.And then entered data into Revman 5.3 or Stata 15software for meta-analysis.Also,the study used the Q test,I~2 statistic,H statistic of Stata15 to do a heterogeneity test;used the Stata15 to perform sensitivity analysis;used the funnel diagram,Begg's funnel plot and Egger's publication bias plot to identify the bias of publication.eight indicators,inluding the stone free rate between PCNL and fURL in treating upper urinary tract stones,the operation time,and the postoperative complications,including the decline of Hb before and after surgery,the number of cases requiring blood transfusion,bleeding/hematuria,fever/infection,pelvis/ureter perforation and the postoperative pain requiring drug analgesia were compared in this paper to find the differences of efficacy and safety between the two surgical methods.ResultsNineteen studies on 1822 patients(n=991 for PCNL and n=831 for fURL)met inclusion criteria.Overall,stone free rate was signifcantly greater in the PCNL group compared to the fURL group[RR=1.07,95%CI(1.03,1.12),P=0.0004<0.05];Hb drop was signifcantly greater in the PCNL group compared to the fURL group[WMD=0.62,95%CI(0.44,0.80),P<0.00001];the number of blood transfusion was signifcantly greater in the PCNL group compared to the fURL group[RR=5.04,95%CI(1.78,14.24),P=0.002<0.05];The incidence of postoperative bleeding or hematuria was signifcantly greater in the PCNL group compared to the fURL group[RR=2.72,95%CI(1.55,4.75),P=0.0005<0.05];operative time was similar in both group[WMD=-1.74,95%CI(-11.75,8.27),P=0.73>0.05];the occurrence rate of pelvis or ureter perforation was not signifcantly different in the PCNL group compared to the f URL group[RR=1.37,95%CI(0.42,4.46),P=0.60>0.05];The incidence of postoperative fever or infection was not signifcantly different in the PCNL group compared to the f URL group[RR=1.23,95%CI(0.86,7.78),P=0.26>0.05];and the rate ofrequiring drug analgesia after surgery was not signifcantly different in the PCNL group compared to the fURL group[RR=1.26,95%CI(0.59,2.68),P=0.55>0.05].ConclusionIn the treatment of upper urinary tract stones,PCNL has higher stone free rate than fURL,but fURL has higher safety profile than PCNL,Therefore,appropriate surgical methods should be selected according to different situations.