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Efficacy and safety of surgical treatment for 1–2 cm sized lower pole of renal stone: network meta-analysis of randomized control trials

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A Correction to this article was published on 03 July 2023

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Abstract

The management of medium-sized (1–2 cm) lower poles renal stone has been a contentious topic for endourologists. There are limited evidences to answer the best management options for medium-sized lower pole renal stone. This network meta-analysis provided high-level evidences on efficacy and safety of profile of PCNL, Mini-PCNL, Ultra-PCNL, RIRS, Micro-PCNL, SWL for management of medium-sized lower pole renal stone. Systemic review and network meta-analysis (NMA) of randomized control trials was conducted. The PICOS (Population, Interventions, Comparison, Outcomes, and Study) approach was used to look for relevant studies. Searches were conducted at major electronic databases like Medline via PubMed, Embase, Google Scholar, SCOPUS, ScienceDirect, Cochrane library, Web of Science, and ClinicalTrials.gov to find relevant articles from the inception to April 19, 2023. Fourteen randomized control trials involving 2194 patients were among these studies that met the eligibility criteria. Pooled SFR was Mini-PNCL 98% (95% CI 96–99%), Ultara-PCNL 96% (95% CI 93–98%), RIRS 90% (95% CI 88–92%), PCNL 88% (95% CI 85–92%), Micro-PCNL 77% (61–88%) and SWL 69% (95% CI 65–74%). Mini-PCNL provided a statistically significant higher SFR compared to RIRS (RR = 2.43 91.52; 3.89)), Micro-PCNL (RR = 3.19 (1.09; 9.38)), and SWL (RR = 6.17 (3.65; 10.44)), but there was no statistical significance with standard PCNL (RR = 1.06 (0.52; 2.16)) and Ultra-PCNL (RR = 1.37 (0.75; 2.51)) for management of medium-sized lower pole renal stone. The order of SUCRA values for complication rate was as follows: PCNL(90%), Micro-PCNL(70%), Mini-PCNL(50%), Ultra-PCNL(50%), RIRS(40%), and SWL(10%). The current pooled evidence from fourteen randomized control trials revealed that Mini-PCNL, Ultra-PCNL, and standard PCNL are likely the best treatments for medium-sized lower poles when SFR over a short period of minimal session is a priority. These treatment options have a higher rate of complications, longer hospital stays, and acceptable operations time. RIRS and SWL treatment have acceptable efficacy stone-free rate with low complication rate, short hospital stays, and operation time. These treatment option would be the best fit for solitary kidney, coagulopathy, and comorbidity.

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Data availability

The data set generated and analyzed during the current study are available from the corrsponding author on reasonable request.

Change history

Abbreviations

PCNL:

Percutaneous nephrolithotomy

m-PCNL:

Mini-percutaneous nephrolithotomy

RIRS:

Retrograde intrarenal surgery

SFR:

Stone-free rate

MD:

Mean difference

RR:

Relative risk

RCT:

Randomized control trial

BPH:

Benign prostate hyperplasia

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Authors and Affiliations

  1. Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia

    Atalel Fentahun Awedew, Yakob Sheiferawe Seman, Dawit Zerihun Yalew, Yohannes Chemere Wondmeneh & Wassie Almaw Yigzaw

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Contributions

Concept note development and draft—AF, protocol development—AF, DZ, YS, WA, YC, searching, screening, and selection—AF, DZ, YS,WA,YC, risk assessment and data extraction—AF, DZ. Data analysis—AF, manuscript writing, editing and review—AF, DZ, YC, WA, YS

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Correspondence to Atalel Fentahun Awedew.

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Awedew, A.F., Seman, Y.S., Yalew, D.Z. et al. Efficacy and safety of surgical treatment for 1–2 cm sized lower pole of renal stone: network meta-analysis of randomized control trials. Urolithiasis 51, 82 (2023). https://doi.org/10.1007/s00240-023-01454-2

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