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01-12-2023 | Urolithiasis | Review

Efficacy and safety of various endosurgical procedures for management of large renal stone: a systemic review and network meta-analysis of randomised control trials

Authors: Atalel Fentahun Awedew, Chalachew Tenna Alemu, Dawit Zerihun Yalew

Published in: Urolithiasis | Issue 1/2023

Abstract

Urolithiasis is the most common benign urological health condition. It has contributed sizeable burden of morbidity, disability, and medical health expenditure worldwide. There is limited high level of evidence on the efficacy and safety of treatment options of large renal stones. This network meta-analysis has examined the effectiveness and safety of various large renal stone management strategies. Systematic review and network meta-analysis (NMA) study design was employed to summarize comparative randomized controlled trials on humans with a diagnosis of renal stone larger than or equal to 2 cm in size. Our searching strategy was based on the Population, Interventions, Comparison, Outcomes, and Study (PICOS) approach. Medline via PubMed, Embase, Google scholar, SCOPUS, Science Direct, Cochrane library, Web of Science, and ClinicalTrials.gov were searched from inception to March 2023 to find eligible articles. Data extraction, screening, selection and risk of bias assessment were conducted by two independent reviewers. We found ten randomised control trials which consists 2917 patients, nine of them were labeled as low risk and one article was high risk. This network meta-analysis found that SFR was 86% (95% CI 84–88%) for Mini-PCNL, 86% (95% CI 84–88%) for standard PCNL, 79% (95% CI:73–86%) for RIRS, and 67% (95%CI:49–81 for staged URS for management of large renal stone. Overall complication rate was 32% (95% CI 27–38%) for standard PCNL, 16% (95% CI 12–21%) for Mini-PCNL, and 11% (95% CI 7–16%) for RIRS. Mini-PCNL (RR = 1.14 (95% CI 1.01–1.27) and PCNL (RR = 1.13 (95% CI 1.01–1.27)) were statistically associated with a higher SFR compared to RIRS. The pooled mean hospital stays were 1.56 days (95% CI 0.93–2.19) for RIRS, 2.96 days (95% CI 1.78–4.14) for Mini-PCNL, 3.9 days (95% CI 2.9–4.83) for standard PCNL, and 3.66 (95% CI 1.13–6.2) for staged URS. Mini-PCNL and standard PCNL were the most effective treatment options with significant morbidity and length of hospital stay, while RIRS was the safest management option with acceptable SFR, low morbidity, and short hospital stay.

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Title: Efficacy and safety of various endosurgical procedures for management of large renal stone: a systemic review and network meta-analysis of randomised control trials
Authors: Atalel Fentahun Awedew
Chalachew Tenna Alemu
Dawit Zerihun Yalew
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/s00240-023-01459-x

At a glance: The STEP trials

Springer Medicine

Efficacy and safety of various endosurgical procedures for management of large renal stone: a systemic review and network meta-analysis of randomised control trials

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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