Comparison between single-shot and gradual dilation technique in percutaneous nephrolithotomy: A systematic review and meta-analysis.

Abstract

Introduction: Percutaneous nephrolithotomy (PCNL) is efficacious for the management of bigger or complex renal calculi. This study assesses the safety and efficacy of single-shot dilation (one-shot - OD) against gradual dilation (multiple - MD) in fluoroscopy-guided PCNL, with the objective of enhancing stone management techniques.

Material and methods: A comprehensive study adhering to PRISMA criteria concentrated on adult patients receiving conventional percutaneous nephrolithotomy for nephrolithiasis. Included were clinical trials and cohort studies comparing OD and MD approaches, but omitting ultrasound-guided, mini, and micro-PCNL methods. Investigations were performed in PubMed, Scopus, EMBASE, Cochrane Library, and Medline from 2008 onwards. Two reviewers independently evaluated and extracted data, employing the Cochrane ROB2 and ROBINS-I instruments for quality evaluation. Statistical analyses utilizing Review Manager 5.4 employed fixed and random-effects models contingent upon heterogeneity (I²).

Results: Sixteen studies (14 randomized controlled trials and 2 cohort studies) including 572 individuals with OD and 581 patients with MD were examined. The meta-analysis indicated a markedly reduced complication rate in the OD group (RR = 0.77; 95% CI: 0.63-0.94; p = 0.01), with no statistically significant difference in stone-free rates (RR = 1.02; 95% CI: 0.97-1.08; p = 0.49). Variations in hemoglobin reduction, duration of hospitalization, fluoroscopy exposure, and surgical time were noted. However, the significant variability requires cautious interpretation.

Conclusions: The single-shot dilation approach showed a markedly reduced complication rate, indicating it as a safer option for adult patients having conventional PCNL. Additional research is required to corroborate these results across various clinical environments.