title: Laparoscopic pyelolithotomy compared to percutaneous nephrolithotomy as surgical management for large renal pelvic calculi: a meta-analysis.
abstract: OBJECTIVE
  We assessed the effectiveness and safety of laparoscopic pyelolithotomy and percutaneous nephrolithotomy as surgical management for solitary renal pelvic calculi larger than 2 cm.
  
  
  METHODS
  We searched PubMed®, EMBASE®, The Cochrane Library and the Web of Knowledge(SM) databases up to November 9, 2012 for relevant published studies. After data extraction and quality assessment, meta-analysis was performed using RevMan 5.1.
  
  
  RESULTS
  We identified 7 trials in a total of 176 and 187 patients treated with laparoscopic pyelolithotomy and percutaneous nephrolithotomy, respectively. Operative time and hospital stay were 50.62 minutes and 0.66 days shorter in the nephrolithotomy group (p <0.0001 and 0.04, respectively). Patients in the laparoscopic group benefited from a lesser decrease in hemoglobin (OR -1.00, 95% CI -1.77--0.23), less postoperative fever (OR 0.24, 95% CI 0.08-0.72), a lower incidence of bleeding (OR 0.29, 95% CI 0.10-0.85) and a higher stone-free rate (OR 4.85, 95% CI 1.59-14.82). Sensitivity analysis indicated that all results were stable except the stone-free rate showed no statistically significant difference between the 2 groups (OR 0.33, 95% CI 0.09-1.17). No publication bias was detected.
  
  
  CONCLUSIONS
  Current evidence suggests that laparoscopic pyelolithotomy and percutaneous nephrolithotomy are effective and safe for large renal pelvic calculi but laparoscopic pyelolithotomy seems to be more advantageous. However, given the inherent limitations of the included studies, results must be further confirmed in high quality randomized, controlled trials.
authors: Department of Urology, Zhongnan Hospital, School of Public Health, State Key Laboratory of Virology (YG), Wuhan University, Wuhan, Hubei Province, People's Republic of China. wangxinghuan1965@gmail.com
authors: Xinghuan
authors: X
authors: Wang
authors: Sheng
authors: S
authors: Li
authors: Tongzu
authors: T
authors: Liu
authors: Yi
authors: Y
authors: Guo
authors: Zhonghua
authors: Z
authors: Yang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000175:diagnosis / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: LP; MD; NRCCT; PCNL; RCT; calculi; kidney; laparoscopic pyelolithotomy; laparoscopy; mean difference; meta-analysis; nephrostomy, percutaneous; nonrandomized, concurrent controlled trial; percutaneous nephrolithotomy; randomized, controlled trial