Minimally invasive percutaneous nephrolithotomy improves stone-free rates for impacted proximal ureteral stones: A systematic review and meta-analysis.
BACKGROUND
Urinary stones are common medical disorders and the treatment of impacted proximal ureteral stones (IPUS) is still a challenge for urologists. The aim of this study was to compare the efficacy and safety of minimally invasive percutaneous nephrolithotomy (MI-PCNL) and ureteroscopic lithotripsy (URL) in the treatment of IPUS via a meta-analysis.


METHODS
We collected studies using PubMed, Embase, and Cochrane Library from 1978 to November 2016 and analyzed them using Stata 12.0 and RevMan 5.3. Odds ratios (ORs) and standard mean difference (SMD) were calculated for binary and continuous variables respectively, accompanied with 95% confidence intervals (CIs). All study procedures followed the PRISMA guidelines.


RESULTS
Five prospective studies were included in our meta-analysis, with 242 MI-PCNL and 256 URL cases. MI-PCNL was associated with a longer postoperative hospital stay than URL (SMD, 3.14; 95% CI, 1.27 to 5.55). However, no significant difference was observed in operative time (SMD, -0.38; 95% CI, -3.15 to 2.38). In addition, MI-PCNL had higher initial (OR, 11.12; 95% CI, 5.56 to 22.24) and overall stone-free rates (OR, 8.70; 95% CI, 3.23 to 23.45) than URL, along with lower possibilities of surgical conversion (OR, 0.11; 95% CI, 0.03 to 0.49) and postoperative shock wave lithotripsy (OR, 0.06; 95% CI, 0.02 to 0.18). Regarding complications, no significant differences were observed between MI-PCNL and URL (OR, 1.39; 95% CI, 0.93 to 2.10), except for hematuria (OR, 4.80; 95% CI, 1.45 to 15.94).


CONCLUSIONS
MI-PCNL is optimal and should be considered as the preferred treatment method for IPUS, as it has better efficacy and a safety profile similar to that of URL. However, further high quality studies with larger sample size are required in future.
Department of Urological Surgery, Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R. China.
Zi-Ming
ZM
Gao
Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, P.R. China.
Shan
S
Gao
Department of Urological Surgery, Liaoning Cancer Hospital/China Medical University Cancer Hospital, Shenyang, Liaoning, P.R. China.
Hong-Chen
HC
Qu
Department of Oncology Surgery, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R. China.
Kai
K
Li
Department of Urological Surgery, Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R. China.
Ning
N
Li
Department of Urological Surgery, Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R. China.
Chun-Lai
CL
Liu
Department of Urological Surgery, Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R. China.
Xing-Wang
XW
Zhu
Department of Urological Surgery, Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R. China.
Yi-Li
YL
Liu
Department of Urological Surgery, Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R. China.
Ping
P
Wang
Department of Cardre Ward, No. 202 Hospital of People's Liberation Army, Shenyang, Liaoning, P.R. China.
Xiao-Hua
XH
Zheng
D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000601:surgery*