Endourological Management of Renal Stones: A Systematic Review, Bayesian Network Meta-analysis and Meta-regression

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology Pub Date : 2025-04-01 DOI:10.1016/j.urology.2024.12.030

David Eugenio Hinojosa-Gonzalez , Gal Saffati , Shane Kronstedt , Connor Rodriguez , Troy La , Richard E. Link , Wesley A. Mayer

{"title":"Endourological Management of Renal Stones: A Systematic Review, Bayesian Network Meta-analysis and Meta-regression","authors":"David Eugenio Hinojosa-Gonzalez , Gal Saffati , Shane Kronstedt , Connor Rodriguez , Troy La , Richard E. Link , Wesley A. Mayer","doi":"10.1016/j.urology.2024.12.030","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To compare stone-free rates (SFRs), operative times, and transfusion rates of various endoscopic techniques for kidney stone management.</div></div><div><h3>Methods</h3><div>A systematic review was performed, identifying studies comparing the different endoscopic techniques in patients with renal stones. Studies were grouped by location and size of stones (lower pole, 1-2cm, and >2 cm). Data were extracted to build a Bayesian network modeling the comparisons. Meta-regression adjusted for variations in stone-free definitions. Odds ratios (OR) with 95% credible intervals were reported.</div></div><div><h3>Results</h3><div>A total of 40 studies were included for analysis, providing a total population of 6696 patients. For lower pole stones, both percutaneous nephrolithotomy (PCNL) (OR 2.0 [1.2, 3.3]) and mini-PCNL (OR 2.3 [1.5, 3.6]) showed increased SFRs when compared to retrograde intrarenal surgery (RIRS), while micro-PCNL exhibited a non-significant difference (OR 0.94 [0.39,2.3]). For stones between 1-2cm, mini-PCNL showed an increased SFR (OR 2.5 [1.5,4.1]) when compared to RIRS; however, there was no significant difference in SFR among the rest of the interventions when compared to RIRS. For stones larger than 2 cm, PCNL, mini-PCNL, and ultramini-PCNL resulted in higher SFRs compared to RIRS.</div></div><div><h3>Conclusion</h3><div>For 1-2cm upper pole/interpolar stones, percutaneous approaches except mini-PCNL did not achieve superior SFRs compared to RIRS. For >2 cm stones and lower pole stones, all percutaneous methods, except micro-PCNL, exhibited higher stone clearance than RIRS.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"198 ","pages":"Pages 193-206"},"PeriodicalIF":2.1000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0090429524012202","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

To compare stone-free rates (SFRs), operative times, and transfusion rates of various endoscopic techniques for kidney stone management.

Methods

A systematic review was performed, identifying studies comparing the different endoscopic techniques in patients with renal stones. Studies were grouped by location and size of stones (lower pole, 1-2 cm, and > 2 cm). Data were extracted to build a Bayesian network modeling the comparisons. Meta-regression adjusted for variations in stone-free definitions. Odds ratios (OR) with 95% credible intervals were reported.

Results

A total of 40 studies were included for analysis, providing a total population of 6696 patients. For lower pole stones, both percutaneous nephrolithotomy (PCNL) (OR 2.0 [1.2, 3.3]) and mini-PCNL (OR 2.3 [1.5, 3.6]) showed increased SFRs when compared to retrograde intrarenal surgery (RIRS), while micro-PCNL exhibited a non-significant difference (OR 0.94 [0.39,2.3]). For stones between 1-2 cm, mini-PCNL showed an increased SFR (OR 2.5 [1.5,4.1]) when compared to RIRS; however, there was no significant difference in SFR among the rest of the interventions when compared to RIRS. For stones larger than 2 cm, PCNL, mini-PCNL, and ultramini-PCNL resulted in higher SFRs compared to RIRS.

Conclusion

For 1-2 cm upper pole/interpolar stones, percutaneous approaches except mini-PCNL did not achieve superior SFRs compared to RIRS. For > 2 cm stones and lower pole stones, all percutaneous methods, except micro-PCNL, exhibited higher stone clearance than RIRS.

查看原文本刊更多论文

肾结石的泌尿系统管理：系统回顾，贝叶斯网络荟萃分析和元回归。

目的：比较肾结石治疗中各种内镜技术的无结石率（SFRs）、手术时间和输血率。方法：进行系统回顾，确定比较肾结石患者不同内窥镜技术的研究。研究按结石的位置和大小分组（下极，1-2 cm和> -2 cm）。提取数据建立贝叶斯网络模型进行比较。元回归调整了无石定义的变化。报告了95%可信区间的优势比（OR）。结果：共纳入40项研究，共纳入6696例患者。对于下极结石，与逆行肾内手术（RIRS）相比，经皮肾镜取石术（PCNL）（OR 2.0[1.2, 3.3]）和迷你肾镜取石术（OR 2.3[1.5, 3.6]）的SFRs均增加，而微型肾镜取石术的SFRs无显著差异（OR 0.94[0.39,2.3]）。对于1-2cm的结石，与RIRS相比，mini-PCNL的SFR增加（OR为2.5[1.5,4.1]）；然而，与RIRS相比，其余干预措施在SFR方面没有显著差异。对于大于2cm的结石，与RIRS相比，PCNL、mini-PCNL和ultra -PCNL导致更高的SFRs。结论：对于1-2cm的上极/极间结石，除mini-PCNL外，经皮入路与RIRS相比并没有取得更好的SFRs。对于bbb20 cm结石和下极结石，除微pcnl外，所有经皮方法的结石清除率均高于RIRS。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Urology 医学-泌尿学与肾脏学

CiteScore

3.30

自引率

9.50%

发文量

716

审稿时长

59 days

期刊介绍： Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.