Mini Versus Standard Percutaneous Nephrolithotomy for the Management of Renal Stone Disease: Systematic Review and Meta-analysis of Randomized Controlled Trials.

Abstract

CONTEXT\nMini percutaneous nephrolithotomy (mPNL) involves the creation of a smaller access tract compared with standard PNL (sPNL). Smaller tract sizes could lead to decreased blood loss, pain, and need for blood transfusion. Previous studies on this topic have reported variable findings and were of poor quality.\n\n\nOBJECTIVE\nTo compare the safety and efficacy of mPNL with those of sPNL for the management of patients with renal stone disease by conducting a systematic review and meta-analysis.\n\n\nEVIDENCE ACQUISITION\nSystematic literature search was performed to identify relevant randomized controlled trials (RCTs) for the review. The primary outcomes for the study were stone-free rate (SFR) and blood transfusion rate. The secondary outcomes were complication rates, fever, fall in hemoglobin, operative time, length of stay (LOS), need for auxiliary procedure, and visual analog scale (VAS) score at 24 h. We followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, and the study protocol was registered with PROSPERO in priori (CRD42021252444).\n\n\nEVIDENCE SYNTHESIS\nIn this review, 16 RCTs with 3961 patients were included. SFR was comparable between the two groups (risk ratio [RR] 1.01 [0.99, 1.04], p = 0.30), whereas the need for transfusion was lower with mPNL (RR 0.54 [0.37, 0.78], p = 0.001). Fall in hemoglobin (mean difference [MD] -0.67 [-0.93, -0.41], p = 0.000) and LOS (MD -0.59 [-0.81, -0.37], p = 0.000) were shorter with mPNL. Operative time was significantly shorter with sPNL (MD 8.28 [3.96, 12.59], p = 0.000). Complications were lower with mPNL (RR 0.89 [0.79, 0.97], p = 0.01). The need for auxiliary procedures (RR 0.77 [0.58, 1.03], p = 0.08) and VAS at 24 h (MD -0.79 [-1.63, 0.05], p = 0.06) were similar in the two groups.\n\n\nCONCLUSIONS\nMini PNL has similar efficacy to sPNL in terms of SFRs. However, mPNL has a superior safety profile with fewer overall complications and a reduced need for blood transfusion.\n\n\nPATIENT SUMMARY\nIn this study, we conducted a meta-analysis comparing mini and standard percutaneous nephrolithotomy (PNL) for the management of patients with renal stone disease. We showed that mini and standard PNL are associated with similar stone-free rates. Overall complications and the need for blood transfusion were lower with mini PNL.