Comparison on Surgical Outcomes of Mini-Versus Standard-Percutaneous Nephrolithotomy in Staghorn Calculi: A Systematic Review and Meta-Analysis.

Abstract

Percutaneous Nephrolithotomy (PCNL) has become the standard for managing staghorn calculi. Smaller access sheath Mini-PCNL (M-PCNL) has been known for its advantages in surgical outcomes compared with Standard-PCNL (S-PCNL) in various settings. We conducted this systematic review to compare surgical outcomes and postoperative complications of M-PCNL vs. S-PCNL in staghorn calculi treatment. A systematic search of the literature was performed on PubMed, Cochrane Library, ProQuest, Scopus, ClinicalTrials.gov, and Google Scholar according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA Statement). Five randomized controlled trial (RCT) and 5 cohort studies were included. Risk of bias assessment was evaluated using Cochrane risk of bias (RoB) 2 and Cochrane RoB in Nonrandomized Studies - of Interventions (ROBINS-I). Ten studies involving 1733 staghorn calculi patients met the inclusion criteria. The stone-free rate (SFR) was comparable (odds ratio (OR) 1.13, 95% CI: 0.90-1.43, P = .28) compared to S-PCNL. Pooled analysis showed that M-PCNL resulted in a significantly lower shorter operative time (mean differences (MD) 14.06, 95% CI: 6.09-22.03, P < .001), lower blood transfusion (OR 0.46, 95% CI: 0.29-0.72, P < .001), and lower hemoglobin drop (MD !0.37, 95% CI: !0.72 to !0.03, P = .03) compared to S-PCNL. This meta-analysis suggests that while M-PCNL has comparable SFR to S-PCNL, it offers benefits in terms of shorter operative time, reduced blood transfusion needs, and less hemoglobin drop.