Top

Published in:

01-12-2023 | Urolithiasis | Research

Determining the safety and effectiveness of percutaneous nephrolithotomy and retrograde intrarenal surgery in treating nephrolithiasis in patients with solitary kidneys

Authors: Lei Peng, Chunyang Meng, Zhongyou Xia, Rui Liang, Lijian Gan, Kangsen Li, Dehong Cao, Yunxiang Li

Published in: Urolithiasis | Issue 1/2023

Abstract

We performed a meta-analysis to compare the safety and effectiveness of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in treating nephrolithiasis ≥ 2 cm in patients with solitary kidneys. This systematic review was registered on PROSPERO (registration ID: CRD42021270519). The search time was set from the establishment of the databases until April 30, 2021. A systematic search was performed in the PubMed, MEDLINE, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), Cochrane Library, and Embase databases. Stata 16 was used to perform the statistical analysis of the extracted data. After screening using strict inclusion and exclusion criteria, five studies with a total of 474 patients were included in the final meta-analysis. According to the literature quality assessment scale statistics, the five studies included were of high quality. The results of the meta-analysis showed that RIRS had lesser hemoglobin loss (HL), shorter length of hospital stay (LOS), lower initial (OR = 3.39, 95% CI [1.97, 5.83], P = 0.02) and final stone-free rates (OR = 2.24, 95% CI [1.24, 4.06], P = 0.03), but a higher incidence of grade III-IV complications (OR = 0.29, 95% CI [0.08, 0.97], P = 0.04) than PCNL. The difference between the two surgical methods was not statistically significant in terms of operation time (OT), grade I–II complication rate, and total complication rate. For nephrolithiasis ≥ 2 cm in patients with a solitary kidney, RIRS has the advantage of less HL and shorter LOS, while PCNL benefits from its higher SFR (both initial and final). Both RIRS and PCNL are effective treatments for nephrolithiasis in patients with a solitary kidney, and clinicians should choose the most appropriate option to achieve the best treatment outcome, taking into account the patient's underlying conditions and medical conditions.

Kuroda S, Fujikawa A, Tabei T, Ito H, Terao H, Yao M, Matsuzaki J (2016) Retrograde intrarenal surgery for urinary stone disease in patients with solitary kidney: A retrospective analysis of the efficacy and safety. Int J Urol 23(1):69–73. https://doi.org/10.1111/iju.12951CrossRefPubMed

Haberal HB, Çıtamak B, Bozacı AC, Yazıcı MS, Aki FT, Bilen CY (2017) Percutaneous Nephrolithotomy in solitary kidneys: 17 years of experience. Urology 109:55–59. https://doi.org/10.1016/j.urology.2017.07.038CrossRefPubMed

Junbo L, Yugen L, Guo J, Jing H, Ruichao Y, Tao W (2019) Retrograde intrarenal surgery vs percutaneous nephrolithotomy vs extracorporeal shock wave lithotripsy for lower pole renal stones 10–20 mm : a meta-analysis and systematic review. Urol J 16(2):97–106. https://doi.org/10.22037/uj.v0i0.4681CrossRefPubMed

Bai Y, Wang X, Yang Y, Han P, Wang J (2017) Percutaneous nephrolithotomy versus retrograde intrarenal surgery for the treatment of kidney stones up to 2 cm in patients with solitary kidney: a single centre experience. BMC Urol 17(1):9. https://doi.org/10.1186/s12894-017-0200-zCrossRefPubMedPubMedCentral

Knoll T, Jessen JP, Honeck P, Wendt-Nordahl G (2011) Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10–30 mm size. World J Urol 29(6):755–759. https://doi.org/10.1007/s00345-011-0784-yCrossRefPubMed

Unsal A, Resorlu B, Atmaca AF, Diri A, Goktug HN, Can CE, Gok B, Tuygun C, Germiyonoglu C (2012) Prediction of morbidity and mortality after percutaneous nephrolithotomy by using the Charlson Comorbidity Index. Urology 79(1):55–60. https://doi.org/10.1016/j.urology.2011.06.038CrossRefPubMed

Tzelves L, Türk C, Skolarikos A (2021) European association of urology urolithiasis guidelines: where are we going? Eur Urol Focus 7(1):34–38. https://doi.org/10.1016/j.euf.2020.09.011CrossRefPubMed

Jones P, Aboumarzouk OM, Rai BP, Somani BK (2017) Percutaneous nephrolithotomy for stones in solitary kidney: evidence from a systematic review. Urology 103:12–18. https://doi.org/10.1016/j.urology.2016.10.022CrossRefPubMed

Jiang K, Zhang P, Xu B, Luo G, Hu J, Zhu J, Sun F (2020) Percutaneous nephrolithotomy vs retrograde intrarenal surgery for renal stones larger than 2 cm in patients with a solitary kidney: a systematic review and a meta-analysis. Urol J 17(5):442–448. https://doi.org/10.22037/uj.v16i7.5609CrossRefPubMed

10.

Skolarikos A, Gross AJ, Krebs A, Unal D, Bercowsky E, Eltahawy E, Somani B, de la Rosette J (2015) Outcomes of flexible ureterorenoscopy for solitary renal stones in the CROES URS global study. J Urol 194(1):137–143. https://doi.org/10.1016/j.juro.2015.01.112CrossRefPubMed

11.

Alenezi H, Denstedt JD (2015) Flexible ureteroscopy: technological advancements, current indications and outcomes in the treatment of urolithiasis. Asian J Urol 2(3):133–141. https://doi.org/10.1016/j.ajur.2015.06.002CrossRefPubMedPubMedCentral

12.

Pan J, Chen Q, Xue W, Chen Y, Xia L, Chen H, Huang Y (2013) RIRS versus mPCNL for single renal stone of 2–3 cm: clinical outcome and cost-effective analysis in Chinese medical setting. Urolithiasis 41(1):73–78. https://doi.org/10.1007/s00240-012-0533-8CrossRefPubMed

13.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clin Res Ed) 372:n71. https://doi.org/10.1136/bmj.n71CrossRef

14.

GA W, B S, C DO The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses.Ottawa Hospital Research Institute Web site. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.

15.

Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ (Clinical Res Ed) 327(7414):557–560. https://doi.org/10.1136/bmj.327.7414.557CrossRef

16.

Patsopoulos NA, Evangelou E, Ioannidis JP (2008) Sensitivity of between-study heterogeneity in meta-analysis: proposed metrics and empirical evaluation. Int J Epidemiol 37(5):1148–1157. https://doi.org/10.1093/ije/dyn065CrossRefPubMedPubMedCentral

17.

Mitropoulos D, Artibani W, Biyani CS, Bjerggaard Jensen J, Rouprêt M, Truss M (2018) Validation of the Clavien-Dindo grading system in urology by the European Association of Urology Guidelines Ad Hoc Panel. Eur Urol Focus 4(4):608–613. https://doi.org/10.1016/j.euf.2017.02.014CrossRefPubMed

18.

Caglayan V, Oner S, Onen E, Avci S, Aydos M, Kilic M, Demirbas M (2018) Percutaneous nephrolithotomy in solitary kidneys: effective, safe and improves renal functions. Minerva Urol Nefrol 70(5):518–525. https://doi.org/10.23736/S0393-2249.18.03123-5CrossRefPubMed

19.

Shi X, Peng Y, Li X, Wang Q, Li L, Liu M, Gao X, Sun Y (2018) Propensity score-matched analysis comparing retrograde intrarenal surgery with percutaneous nephrolithotomy for large stones in patients with a solitary kidney. J Endourol 32(3):198–204. https://doi.org/10.1089/end.2017.0482CrossRefPubMed

20.

Zeng G, Zhu W, Li J, Zhao Z, Zeng T, Liu C, Liu Y, Yuan J, Wan SP (2015) The comparison of minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery for stones larger than 2 cm in patients with a solitary kidney: a matched-pair analysis. World J Urol 33(8):1159–1164. https://doi.org/10.1007/s00345-014-1420-4CrossRefPubMed

21.

Zhang Y, Wu Y, Li J, Zhang G (2018) Comparison of percutaneous nephrolithotomy and retrograde intrarenal surgery for the treatment of lower calyceal calculi of 2–3 cm in patients with solitary kidney. Urology 115:65–70. https://doi.org/10.1016/j.urology.2017.11.063CrossRefPubMed

22.

Frassetto L, Kohlstadt I (2011) Treatment and prevention of kidney stones: an update. Am Fam Phys 84(11):1234–1242

23.

Giusti G, Proietti S, Cindolo L, Peschechera R, Sortino G, Berardinelli F, Taverna G (2015) Is retrograde intrarenal surgery a viable treatment option for renal stones in patients with solitary kidney? World J Urol 33(3):309–314. https://doi.org/10.1007/s00345-014-1305-6CrossRefPubMed

24.

Hosseini MM, Yousefi A, Hassanpour A, Jahanbini S, Zaki-Abbasi M (2015) Percutaneous nephrolithotomy in solitary kidneys: experience with 412 cases from Southern Iran. Urolithiasis 43(3):233–236. https://doi.org/10.1007/s00240-014-0743-3CrossRefPubMed

25.

Shoma AM, Elshal AM (2012) Nephrostomy tube placement after percutaneous nephrolithotomy: critical evaluation through a prospective randomized study. Urology 79(4):771–776. https://doi.org/10.1016/j.urology.2011.09.042CrossRefPubMed

26.

Zhong W, Zhao Z, Wang L, Swami S, Zeng G (2015) Percutaneous-based management of Staghorn calculi in solitary kidney: combined mini percutaneous nephrolithotomy versus retrograde intrarenal surgery. Urol Int 94(1):70–73. https://doi.org/10.1159/000360708CrossRefPubMed

27.

Dong X, Ren Y, Han P, Chen L, Sun T, Su Y, Feng Y, Ma J, Liang H, Zheng C (2020) Superselective renal artery embolization management of post-percutaneous nephrolithotomy hemorrhage and its methods. Front Surg 7:582261. https://doi.org/10.3389/fsurg.2020.582261CrossRefPubMedPubMedCentral

28.

Gao X, Peng Y, Shi X, Li L, Zhou T, Xu B, Sun Y (2014) Safety and efficacy of retrograde intrarenal surgery for renal stones in patients with a solitary kidney: a single-center experience. J Endourol 28(11):1290–1294. https://doi.org/10.1089/end.2014.0295CrossRefPubMed

29.

Inoue T, Okada S, Hamamoto S, Fujisawa M (2021) Retrograde intrarenal surgery: Past, present, and future. Investig Clin Urol 62(2):121–135. https://doi.org/10.4111/icu.20200526CrossRefPubMedPubMedCentral

30.

Keller EX, De Coninck V, Doizi S, Traxer O (2020) The role of ureteroscopy for treatment of staghorn calculi: A systematic review. Asian J Urol 7(2):110–115. https://doi.org/10.1016/j.ajur.2019.10.012CrossRefPubMed

31.

Geraghty RM, Rai BP, Jones P, Somani BK (2017) Bilateral simultaneous ureteroscopic (BS-URS) approach in the management of bilateral urolithiasis is a safe and effective strategy in the contemporary Era-evidence from a systematic review. Curr Urol Rep 18(2):11. https://doi.org/10.1007/s11934-017-0660-4CrossRefPubMedPubMedCentral

32.

D’Costa M, Savcic-Kos R, Huang J, Rule AD, Murali N (2016) Urological procedures in urolithiasis and their association with chronic kidney disease. Clin Med Res 14(2):75–82. https://doi.org/10.3121/cmr.2016.1261CrossRefPubMedPubMedCentral

Title: Determining the safety and effectiveness of percutaneous nephrolithotomy and retrograde intrarenal surgery in treating nephrolithiasis in patients with solitary kidneys
Authors: Lei Peng
Chunyang Meng
Zhongyou Xia
Rui Liang
Lijian Gan
Kangsen Li
Dehong Cao
Yunxiang Li
Publication date: 01-12-2023
Publisher: Springer Berlin Heidelberg
Keyword: Urolithiasis
Published in: Urolithiasis / Issue 1/2023
Print ISSN: 2194-7228
Electronic ISSN: 2194-7236
DOI: https://doi.org/10.1007/s00240-022-01386-3

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Determining the safety and effectiveness of percutaneous nephrolithotomy and retrograde intrarenal surgery in treating nephrolithiasis in patients with solitary kidneys

Abstract

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2023

Conflicts of interest and the risk of bias are inevitable in urolithiasis research

Epitranscriptomic profiling of m6A RNA methylation in renal epithelial tubular cells stimulated with calcium oxalate crystals through microarray analysis

Microureteroscopy in the treatment of upper urinary tract stones in pediatric patients younger than 3 years of age

An insight investigation to the antiurolithic activity of Trachyspermum ammi using the in vitro and in vivo experiments

Kidney function may partially mediated the protective effect of urinary uromodulin on kidney stone

Which position is more advantageous for percutaneous nephrolithotomy: supine or prone?