Comparison of mini percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for renal stones &gt;2cm: a systematic review and meta-analysis

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ABSTRACT

Background

The purpose is to compare the efficacy and safety of mini percutaneous nephrolithotomy (mini-PCNL) versus standard percutaneous nephrolithotomy (standard-PCNL) in patients with renal stones >2cm.

Materials and Methods

A systematic literature search was conducted in PubMed, Web of Science, Scopus, and the Cochrane Library databases to identify relevant studies before March 8, 2021. Stone-free rate (SFR), operation time, fever rate, hemoglobin drop, blood transfusion rate, and hospitalization time were used as outcomes to compare mini-PCNL and standard-PCNL. The meta-analysis was performed using the Review Manager version 5.4.

Results

Seven randomized controlled trials were included in our meta-analysis, involving 1407 mini-PCNL cases and 1436 standard-PCNL cases. Our results reveal that, for renal stones >2cm, mini-PCNL has a similar SFR (risk ratio (RR)=1.01, 95% confidence interval (CI): 0.98 to 1.04, p=0.57) and fever rate (RR=1.22, 95% CI: 0.97-1.51, p=0.08). Standard-PCNL was associated with a significantly shorter operating time (weighted mean difference (WMD)=8.23, 95% CI: 3.44 to 13.01, p <0.01) and a longer hospitalization time (WMD=-20.05, 95% CI: -29.28 to -10.81, p <0.01) than mini-PCNL. Subgroup analysis showed hemoglobin drop and blood transfusion for 30F standard-PCNL were more common than mini-PCNL (WMD=-0.95, 95% CI: -1.40 to -0.50, p <0.01; RR=0.20, 95% CI: 0.07 to 0.58, p <0.01).

Conclusion

In the treatment of >2cm renal stones, mini-PCNL should be considered an effective and reliable alternative to standard-PCNL (30F). It achieves a comparable SFR to standard-PCNL, but with less blood loss, lower transfusion rate, and shorter hospitalization. However, the mini-PCNL does not show a significant advantage over the 24F standard-PCNL. On the contrary, this procedure takes a longer operation time.

Trial registration

This meta-analysis was reported consistent with the PRISMA statement and was registered on PROSPERO, with registration number 2021CRD42021234893.

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Most cited references 32

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Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range

Xiang Wan, Wenqian Wang, Jiming Liu … (2014)

Background In systematic reviews and meta-analysis, researchers often pool the results of the sample mean and standard deviation from a set of similar clinical trials. A number of the trials, however, reported the study using the median, the minimum and maximum values, and/or the first and third quartiles. Hence, in order to combine results, one may have to estimate the sample mean and standard deviation for such trials. Methods In this paper, we propose to improve the existing literature in several directions. First, we show that the sample standard deviation estimation in Hozo et al.’s method (BMC Med Res Methodol 5:13, 2005) has some serious limitations and is always less satisfactory in practice. Inspired by this, we propose a new estimation method by incorporating the sample size. Second, we systematically study the sample mean and standard deviation estimation problem under several other interesting settings where the interquartile range is also available for the trials. Results We demonstrate the performance of the proposed methods through simulation studies for the three frequently encountered scenarios, respectively. For the first two scenarios, our method greatly improves existing methods and provides a nearly unbiased estimate of the true sample standard deviation for normal data and a slightly biased estimate for skewed data. For the third scenario, our method still performs very well for both normal data and skewed data. Furthermore, we compare the estimators of the sample mean and standard deviation under all three scenarios and present some suggestions on which scenario is preferred in real-world applications. Conclusions In this paper, we discuss different approximation methods in the estimation of the sample mean and standard deviation and propose some new estimation methods to improve the existing literature. We conclude our work with a summary table (an Excel spread sheet including all formulas) that serves as a comprehensive guidance for performing meta-analysis in different situations. Electronic supplementary material The online version of this article (doi:10.1186/1471-2288-14-135) contains supplementary material, which is available to authorized users.

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Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range

Dehui Luo, Tiejun Tong, Jiming Liu … (2016)

The era of big data is coming, and evidence-based medicine is attracting increasing attention to improve decision making in medical practice via integrating evidence from well designed and conducted clinical research. Meta-analysis is a statistical technique widely used in evidence-based medicine for analytically combining the findings from independent clinical trials to provide an overall estimation of a treatment effectiveness. The sample mean and standard deviation are two commonly used statistics in meta-analysis but some trials use the median, the minimum and maximum values, or sometimes the first and third quartiles to report the results. Thus, to pool results in a consistent format, researchers need to transform those information back to the sample mean and standard deviation. In this article, we investigate the optimal estimation of the sample mean for meta-analysis from both theoretical and empirical perspectives. A major drawback in the literature is that the sample size, needless to say its importance, is either ignored or used in a stepwise but somewhat arbitrary manner, e.g. the famous method proposed by Hozo et al. We solve this issue by incorporating the sample size in a smoothly changing weight in the estimators to reach the optimal estimation. Our proposed estimators not only improve the existing ones significantly but also share the same virtue of the simplicity. The real data application indicates that our proposed estimators are capable to serve as "rules of thumb" and will be widely applied in evidence-based medicine.

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Factors affecting blood loss during percutaneous nephrolithotomy: prospective study.

Rajesh Kukreja, Mihir Desai, Snehal Patel … (2004)

Bleeding is a major concern during percutaneous nephrolithotomy (PCNL), especially with the use of multiple tracts. This prospective study aimed to identify factors affecting blood loss during PCNL. Data were collected prospectively from 236 patients undergoing 301 PCNL procedures at our institute since June 2002. Blood loss was estimated by the postoperative drop in hemoglobin factored by the quantity of any blood transfusion. Various patient-related and intraoperative factors were assessed for association with total blood loss or blood transfusion requirement using stepwise multivariate regression analysis. The average hemoglobin drop was 1.68 +/- 1.23 g/dL. Stepwise multivariate regression analysis showed that the occurrence of operative complications (P or =2) tracts (P = 0.003), size of the tract (P = 0.001), renal parenchymal thickness (P = 0.05), and diabetes (P = 0.05) were significant predictors of blood loss. The overall blood transfusion rate for all patients was 7.9%. Preoperative hemoglobin, multiple tracts, stone size, and total blood loss were significant in predicting perioperative blood transfusion requirement. Factors such as age, hypertension, renal insufficiency, urinary infection, the degree of hydronephrosis, stone bulk, and the function of the ipsilateral renal unit did not have any effect on the blood loss. Technical factors such as the operating surgeon and the calix of entry also did not affect the blood loss. Diabetes, multiple-tract procedures, prolonged operative time, and the occurrence of intraoperative complications are associated with significantly increased blood loss. Atrophic parenchyma and past ipsilateral intervention are associated with reduced blood loss. On the basis of this evidence, maneuvers that may reduce blood loss and transfusion rate include ultrasound-guided access, use of Amplatz or balloon dilatation systems, reducing the operative time, and staging the procedure in cases of a large stone burden or intraoperative complications. Reducing the tract size in pediatric cases, nonhydronephrotic systems and those with a narrow infundibulum, and secondary tracts in a multiple-tract procedure may also reduce blood loss during PCNL.

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Author and article information

Journal

Journal ID (nlm-ta): Int Braz J Urol

Journal ID (iso-abbrev): Int Braz J Urol

Journal ID (publisher-id): ibju

Title: International Brazilian Journal of Urology : Official Journal of the Brazilian Society of Urology

Publisher: Sociedade Brasileira de Urologia

ISSN (Print): 1677-5538

ISSN (Electronic): 1677-6119

Publication date (Electronic): 08 October 2021

Publication date Collection: Jul-Aug 2022

Volume: 48

Issue: 4

Pages: 637-648

Affiliations

[1 ] orgdiv1School of Medicine orgnameNingbo University Ningbo Zhejiang China original School of Medicine, Ningbo University, Ningbo, Zhejiang, China;

[2 ] orgdiv2Department of Urology orgdiv1The Center for Uro-nephrological Diseases orgnameNingbo First Hospital Ningbo Zhejiang China originalDepartment of Urology, The Center for Uro-nephrological Diseases, Ningbo First Hospital, Ningbo, Zhejiang, China;

Author notes

Correspondence address: Yue Cheng, MD Department of Urology, The Center for Uro-nephrological Diseases, Ningbo First Hospital, Ningbo, Zhejiang, China E-mail: dongbaba8@ 123456hotmail.com

CONFLICT OF INTEREST

None declared.

Author information

Pengfei Qin https://orcid.org/0000-0002-9178-5733

Article

Publisher ID: S1677-5538.IBJU.2021.0347

DOI: 10.1590/S1677-5538.IBJU.2021.0347

PMC ID: 9306366

PubMed ID: 34786926

SO-VID: f53aef60-5d8d-4df1-a552-6175434127cd

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 26 July 2021

Date accepted : 10 September 2021

Page count

Figures: 3, Tables: 2, Equations: 0, References: 29, Pages: 12

Funding

Funded by: Medical and Health Science and Technology Project of Zhejiang Province

Award ID: 2019326541

FUNDING INFORMATION: Medical and Health Science and Technology Project of Zhejiang Province number: 2019326541

Comparison of mini percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for renal stones >2cm: a systematic review and meta-analysis

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Most cited references 32

Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range

Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range

Factors affecting blood loss during percutaneous nephrolithotomy: prospective study.

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