Efficacy and safety of laparoscopic pyelolithotomy <i>versus</i> percutaneous nephrolithotomy in large renal pelvic calculi: a meta-analysis _Chinese Journal of Evidence-Based Medicine

Authors：

LIU Wei ^1,2,3 ^# , YANG Enguang ^1,2,3 ^# , GAO Dongyang ^1,2,3 , PANG Yangyang ^1,2,3 , TIAN Jinhui ^4,5,6 , GUO Qi ^1,2,3 , GONG Yuwen ^1,2,3 , LI Diyin ^1,2,3 , ZHANG Tao ^1,2,3 , WANG Yuhan ^1,2,3 ,  WANG Zhiping ^1,2,3

1. Institute of Urology, the Second Hospital, Lanzhou University, Lanzhou, 730030, P.R.China;
2. Key Laboratory of Gansu Province for Urological Diseases, Lanzhou, 730030, P.R.China;
3. Gansu Nephro-Urological Clinical Center, Lanzhou, 730030, P.R.China;
4. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, P.R.China;
5. Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, P.R.China;
6. Chinese GRADE Center, Lanzhou University, Lanzhou, 730000, P.R.China;

Corresponding?author：

WANG Zhiping, Email: erywzp@lzu.edu.cn

Keywords：

Pyelolithotomy; Percutaneous nephrolithotomy; Renal pelvic calculi; Randomized controlled trial; Meta-analysis

DOI：

10.7507/1672-2531.201711120

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ObjectivesTo systematically review the efficacy and safety of laparoscopic pyelolithotomy (LP) versus percutaneous nephrolithotomy (PNL) in treating large (>2 cm) renal pelvic calculi.MethodsDatabases including PubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI and WanFang Data were searched for relevant randomized controlled trials (RCTs) comparing LP with PNL for the treatment of large renal pelvic calculi from inception to September 23^th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of eligible studies. Meta-analysis was then performed by using RevMan 5.2 software.ResultsFive RCTs with 447 patients were included. The results of meta-analysis showed that: compared with PNL group, LP group provided a significantly higher stone-free rate (RR=1.07, 95%CI 1.01 to 1.13, P=0.01), lower auxiliary procedure rate (RR=0.36, 95%CI 0.13 to 1.01, P=0.05), less hemoglobin decrease (MD=–0.83, 95%CI –1.05 to –0.61, P<0.000 01) and lower postoperative fever rate (RR=0.36, 95%CI 0.18 to 0.72,P=0.004). However, no significant differences were detected in conversion rate (RR=0.76, 95%CI 0.19 to 3.07, P=0.70), blood transfusion rate (RR=0.40, 95%CI 0.14, to 1.12, P=0.08), postoperative leakage rate (RR=1.87, 95%CI 0.67 to 5.21, P=0.23), operative time (MD=10.49, 95%CI –17.14 to 38.13, P=0.46) and hospital stay (MD=0.53, 95%CI –0.22 to 1.28, P=0.17).ConclusionsLP is superior to PNL with regard to stone-free rate, auxiliary procedure rate, hemoglobin decrease and postoperative fever rate. Due to limited quality and quantity of included studies, more high quality studies are required to verify above conclusions.

Citation： LIU Wei, YANG Enguang, GAO Dongyang, PANG Yangyang, TIAN Jinhui, GUO Qi, GONG Yuwen, LI Diyin, ZHANG Tao, WANG Yuhan, WANG Zhiping. Efficacy and safety of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in large renal pelvic calculi: a meta-analysis . Chinese Journal of Evidence-Based Medicine, 2018, 18(9): 947-952. doi: 10.7507/1672-2531.201711120 Copy

1.	Zeng G, Mai Z, Xia S, et al. Prevalence of kidney stones in China: an ultrasonography based cross-sectional study. BJU Int, 2017, 120(1): 109-116.
2.	Fernstr?m I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol, 1976, 10(3): 257-259.
3.	Bai Y, Tang Y, Deng L, et al. Management of large renal stones: laparoscopic pyelolithotomy versus percutaneous nephrolithotomy. BMC Urol, 2017, 17(1): 75.
4.	Simforoosh N, Aminsharifi A. Laparoscopic management in stone disease. Curr Opin Urol, 2013, 23(2): 169-174.
5.	Wang X, Li S, Liu T, et al. Laparoscopic pyelolithotomy compared to percutaneous nephrolithotomy as surgical management for large renal pelvic calculi: a meta-analysis. J Urol, 2013, 190(3): 888-893.
6.	Soucy F, Ko R, Duvdevani M, et al. Percutaneous nephrolithotomy for staghorn calculi: a single center's experience over 15 years. J Endourol, 2009, 23(10): 1669-1673.
7.	Gandhi HR, Thomas A, Nair B, et al. Laparoscopic pyelolithotomy: an emerging tool for complex staghorn nephrolithiasis in high-risk patients. Arab J Urol, 2015, 13(2): 139-145.
8.	郭念湘, 黃善飛, 易偉國, 等. 腹腔鏡技術治療上尿路結石58例臨床觀察. 實用醫藥雜志, 2017, 34(5): 432-433.
9.	曾憲濤, 包翠萍, 曹世義, 等. Meta分析系列之三: 隨機對照試驗的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(3): 183-185.
10.	Al-Hunayan A, Khalil M, Hassabo M, et al. Management of solitary renal pelvic stone: laparoscopic retroperitoneal pyelolithotomy versus percutaneous nephrolithotomy. J Endourol, 2011, 25(6): 975-978.
11.	Basiri A, Tabibi A, Nouralizadeh A, et al. Comparison of safety and efficacy of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in patients with renal pelvic stones: a randomized clinical trial. Urol J, 2014, 11(6): 1932-1937.
12.	Li S, Liu TZ, Wang XH, et al. Randomized controlled trial comparing retroperitoneal laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for the treatment of large renal pelvic calculi: a pilot study. J Endourol, 2014, 28(8): 946-950.
13.	Singh V, Sinha RJ, Gupta DK, et al. Prospective randomized comparison of retroperitoneoscopic pyelolithotomy versus percutaneous nephrolithotomy for solitary large pelvic kidney stones. Urol Int, 2014, 92(4): 392-395.
14.	Fawzi AM, Ali AR, Shello HE, et al. Retroperitoneal laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of renal pelvis stones: a prospective randomized study. Eur Urol Suppl[Internet], 2015, 14(2): e588. Available at: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/997/CN-01077997/frame.html.
15.	Türk C, Neisius A, Petrik A, et al. EAU guidelines on urolithiasis. European Association of Urology (EAU), 2017. Available at: http://uroweb.org/guideline/urolithiasis/.
16.	Aminsharifi A, Hosseini MM, Khakbaz A. Laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for a solitary renal pelvis stone larger than 3 cm: a prospective cohort study. Urolithiasis, 2013, 41(6): 493-497.
17.	Lee JW, Cho SY, Jeong CW, et al. Comparison of surgical outcomes between laparoscopic pyelolithotomy and percutaneous nephrolithotomy in patients with multiple renal stones in various parts of the pelvocalyceal system. J Laparoendosc Adv Surg Tech A, 2014, 24(9): 634-639.
18.	Goel A, Hemal AK. Evaluation of role of retroperitoneoscopic pyelolithotomy and its comparison with percutaneous nephrolithotripsy. Int Urol Nephrol, 2003, 35(1): 73-76.
19.	蒲小勇, 劉久敏, 畢學成, 等. 腹腔鏡腎盂切開取石術與經皮腎鏡碎石取石術在大于2.5 cm腎盂結石處理中的臨床效果比較. 南方醫科大學學報, 2017, 37(2): 251-255.
20.	俞家順, 王健, 劉定益, 等. 后腹腔鏡腎竇內腎盂切開取石術與經皮腎鏡碎石取石術的術后創傷程度比較. 海南醫學院學報, 2017, 23(15): 2102-2104.
21.	黃韜, 呂磊, 王勇軍, 等. 超聲引導下經皮腎鏡取石術中腎盂內壓變化與術后發熱的關系. 臨床泌尿外科雜志, 2013, 28(4): 292-294.

1. Zeng G, Mai Z, Xia S, et al. Prevalence of kidney stones in China: an ultrasonography based cross-sectional study. BJU Int, 2017, 120(1): 109-116.
2. Fernstr?m I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol, 1976, 10(3): 257-259.
3. Bai Y, Tang Y, Deng L, et al. Management of large renal stones: laparoscopic pyelolithotomy versus percutaneous nephrolithotomy. BMC Urol, 2017, 17(1): 75.
4. Simforoosh N, Aminsharifi A. Laparoscopic management in stone disease. Curr Opin Urol, 2013, 23(2): 169-174.
5. Wang X, Li S, Liu T, et al. Laparoscopic pyelolithotomy compared to percutaneous nephrolithotomy as surgical management for large renal pelvic calculi: a meta-analysis. J Urol, 2013, 190(3): 888-893.
6. Soucy F, Ko R, Duvdevani M, et al. Percutaneous nephrolithotomy for staghorn calculi: a single center's experience over 15 years. J Endourol, 2009, 23(10): 1669-1673.
7. Gandhi HR, Thomas A, Nair B, et al. Laparoscopic pyelolithotomy: an emerging tool for complex staghorn nephrolithiasis in high-risk patients. Arab J Urol, 2015, 13(2): 139-145.
8. 郭念湘, 黃善飛, 易偉國, 等. 腹腔鏡技術治療上尿路結石58例臨床觀察. 實用醫藥雜志, 2017, 34(5): 432-433.
9. 曾憲濤, 包翠萍, 曹世義, 等. Meta分析系列之三: 隨機對照試驗的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(3): 183-185.
10. Al-Hunayan A, Khalil M, Hassabo M, et al. Management of solitary renal pelvic stone: laparoscopic retroperitoneal pyelolithotomy versus percutaneous nephrolithotomy. J Endourol, 2011, 25(6): 975-978.
11. Basiri A, Tabibi A, Nouralizadeh A, et al. Comparison of safety and efficacy of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in patients with renal pelvic stones: a randomized clinical trial. Urol J, 2014, 11(6): 1932-1937.
12. Li S, Liu TZ, Wang XH, et al. Randomized controlled trial comparing retroperitoneal laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for the treatment of large renal pelvic calculi: a pilot study. J Endourol, 2014, 28(8): 946-950.
13. Singh V, Sinha RJ, Gupta DK, et al. Prospective randomized comparison of retroperitoneoscopic pyelolithotomy versus percutaneous nephrolithotomy for solitary large pelvic kidney stones. Urol Int, 2014, 92(4): 392-395.
14. Fawzi AM, Ali AR, Shello HE, et al. Retroperitoneal laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of renal pelvis stones: a prospective randomized study. Eur Urol Suppl[Internet], 2015, 14(2): e588. Available at: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/997/CN-01077997/frame.html.
15. Türk C, Neisius A, Petrik A, et al. EAU guidelines on urolithiasis. European Association of Urology (EAU), 2017. Available at: http://uroweb.org/guideline/urolithiasis/.
16. Aminsharifi A, Hosseini MM, Khakbaz A. Laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for a solitary renal pelvis stone larger than 3 cm: a prospective cohort study. Urolithiasis, 2013, 41(6): 493-497.
17. Lee JW, Cho SY, Jeong CW, et al. Comparison of surgical outcomes between laparoscopic pyelolithotomy and percutaneous nephrolithotomy in patients with multiple renal stones in various parts of the pelvocalyceal system. J Laparoendosc Adv Surg Tech A, 2014, 24(9): 634-639.
18. Goel A, Hemal AK. Evaluation of role of retroperitoneoscopic pyelolithotomy and its comparison with percutaneous nephrolithotripsy. Int Urol Nephrol, 2003, 35(1): 73-76.
19. 蒲小勇, 劉久敏, 畢學成, 等. 腹腔鏡腎盂切開取石術與經皮腎鏡碎石取石術在大于2.5 cm腎盂結石處理中的臨床效果比較. 南方醫科大學學報, 2017, 37(2): 251-255.
20. 俞家順, 王健, 劉定益, 等. 后腹腔鏡腎竇內腎盂切開取石術與經皮腎鏡碎石取石術的術后創傷程度比較. 海南醫學院學報, 2017, 23(15): 2102-2104.
21. 黃韜, 呂磊, 王勇軍, 等. 超聲引導下經皮腎鏡取石術中腎盂內壓變化與術后發熱的關系. 臨床泌尿外科雜志, 2013, 28(4): 292-294.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in large renal pelvic calculi: a meta-analysis

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