Effectiveness and Safety of Flexible Ureteroscope Lithtripsy and Percutaneous Nephrolithotomy for Renal Calculus: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

NIU Chao , LIAO Banghua , LUO Deyi ,  WANG Kunjie

Department of Urology, West China Hospital of Sichuan University, Chengdu 610041, China;

Corresponding author：

WANG Kunjie, Email: wzwzl@yahoo.com.cn

Keywords：

Renal calculus; Flexible ureteroscope lithtripsy; Percutaneous nephrolithotomy; Systematic Review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20130153

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To systematically review the effectiveness and safety of flexible ureteroscope lithtripsy (fURL) and percutaneous nephrolithotomy (PCNL) in treating renal calculus.
Methods 　Such databases as MEDLINE, EMbase, The Cochrane Library, CNKI, CBM, VIP, and WanFang Data from January, 1990 to August, 2012 were searched to comprehensively collect the clinical trials that compared fURL and PCNL in treating renal calculus. Two reviewers independently screened studies according to exclusion and inclusion criteria, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.1 software.
Results 　Eight non-randomized controlled trials involving 536 patients were included. The results of meta-analysis showed that, PCNL was better than fURL in stone clearance (OR=0.26, 95%CI 0.15 to 0.46), but fURL was better than PCNL in postoperative pyrexia (OR=0.1, 95%CI 0.42 to 3.35), the incidence of blood transfusion (OR=0.17, 95%CI 0.03 to 1.00), and the duration of hospitalization (P=0.45, I2=0%).
Conclusion 　Current evidence has proved that PCNL is better than fURL in decreasing stone clearance, fURL is better than PCNL in complication, the duration of hospitalization, and medical costs.

Citation： NIU Chao,LIAO Banghua,LUO Deyi,WANG Kunjie. Effectiveness and Safety of Flexible Ureteroscope Lithtripsy and Percutaneous Nephrolithotomy for Renal Calculus: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2013, 13(7): 868-874. doi: 10.7507/1672-2531.20130153 Copy

1.	吴孟超, 吴在德, 主编. 黄家驷外科学. 第7版. 北京: 人民卫生出版社, 2008: 1432-1980.
2.	石美鑫, 主编. 实用外科学. 第2版. 北京: 人民卫生出版社, 2005: 2405-2410.
3.	岐宏政, 沈鹏飞, 刘勇, 等. 肾镜取石术与开放手术治疗肾结石的系统评价. 中华腔镜泌尿外科杂志(电子版), 2009, 3(5): 382-388.
4.	程跃, 刘冠琳, 输尿管软镜治疗上尿路结石的现状与展望. 现代实用医学, 2012, 24(6): 603-606.
5.	刘鸣, 主编. 系统评价、META-分析设计与实验方法. 第1版. 北京: 人民卫生出版社, 2011: 98-117.
6.	Hyams ES, Shah O. Percutaneous nephrostolithotomy versus flexible ureteroscopy/holmium laser lithotripsy: cost and outcome analysis. J Urol, 2009, 182(3): 1012-1017.
7.	Akman T, Binbay M, Ozgor F, et al. Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2-4 cm stones: a matched-pair analysis. BJU Int, 2012, 109(9): 1384-1389.
8.	Akman T, Binbay M, Ugurlu M, et al. Outcomes of retrograde intrarenal surgery compared with percutaneous nephrolithotomy in elderly patients with moderate-size kidney stones: a matched-pair analysis. J Endourol, 2012, 26(6): 625-629.
9.	Bozkurt OF, Resorlu B, Yildiz Y, et al. Retrograde intrarenal surgery versus percutaneous nephrolithotomy in the management of lower-pole renal stones with a diameter of 15 to 20 mm. J Endourol, 2011, 25(7): 1131-1135.
10.	Knoll T, Jessen JP, Honeck P, et al. Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10-30 mm size. World J Urol, 2011, 29(6): 755-759.
11.	Chung BI, Aron M, Hegarty NJ, et al. Ureteroscopic versus percutaneous treatment for medium-size (1-2-cm) renal calculi. J Endourol, 2008, 22(2): 343-346.
12.	高小峰, 周铁, 陈书尚, 等. 输尿管软镜碎石与微创经皮肾取石术治疗肾盏结石的对比研究. 中华腔镜泌尿外科杂志, 2007, 1(2): 69-72.
13.	施小东, 程跃, 邱中笑, 等. 电子输尿管软镜碎石术治疗肾结石疗效观察. 现代实用医学, 2012, 22(9): 1018-1019.
14.	Okhunov Z, Friedlander JI, George AK, et al. STONE Nephrolithometry: Novel Surgical Classification System for Kidney Calculi. Urology, 2013, 21(8): 659-694.
15.	Yili L, Yongzhi L, Ning L, et al. Flexible ureteroscopy and holmium laser lithotripsy for treatment of upper urinary tract calculi in patients with autosomal dominant polycystic kidney disease. Urol Res, 2012, 40(1): 87-91.
16.	Falahatkar S, Khosropanah I, Allahkhah A, et al. Open surgery, laparoscopic surgery, or transureteral lithotripsy—which method? Comparison of ureteral stone management outcomes. Journal of Endourology, 2011, 25(1): 31-34.
17.	Agarwal M, Agrawal MS, Jaiswal A, et al. Safety and efficacy of ultrasonography as an adjunct to fluoroscopy for renal access in percutaneous nephrolithotomy (PCNL). BJU International, 2011, 108(8): 1346-1349.
18.	Multescu R, Geavlete B, Georgescu D, et al. Conventional fiberoptic flexible ureteroscope versus fourth generation digital flexible ureteroscope: A critical comparison. J Endourol, 2010, 24(1): 17-21.
19.	Perlmutter AE, Talug C, Tarry WF, et al. Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis. Urology, 2008, 71(2): 214-217.
20.	Molimard B, Al-Qahtani S, Lakmichi A, et al. Flexible ureterorenoscopy with holmium laser in horseshoe kidneys. Urology, 2010, 76(6): 1334-1337.
21.	El-Nahas AR, Ibrahim HM, Youssef RF, et al. Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for treatment of lower pole stones of 10-20 mm. BJU Int, 2012, 110(6): 898-902.
22.	马建伟, 程跃. 输尿管软镜治疗上尿路结石新进展. 临床泌尿外科杂志, 2012, 27(5): 398-400.
23.	Rippel CA, Nikkel L, Lin YK, et al. Residual fragments following ureteroscopic lithotripsy: incidence and predictors on postoperative computerized tomography. J Urol, 2012, 188(6): 2246-2251.

1. 吴孟超, 吴在德, 主编. 黄家驷外科学. 第7版. 北京: 人民卫生出版社, 2008: 1432-1980.
2. 石美鑫, 主编. 实用外科学. 第2版. 北京: 人民卫生出版社, 2005: 2405-2410.
3. 岐宏政, 沈鹏飞, 刘勇, 等. 肾镜取石术与开放手术治疗肾结石的系统评价. 中华腔镜泌尿外科杂志(电子版), 2009, 3(5): 382-388.
4. 程跃, 刘冠琳, 输尿管软镜治疗上尿路结石的现状与展望. 现代实用医学, 2012, 24(6): 603-606.
5. 刘鸣, 主编. 系统评价、META-分析设计与实验方法. 第1版. 北京: 人民卫生出版社, 2011: 98-117.
6. Hyams ES, Shah O. Percutaneous nephrostolithotomy versus flexible ureteroscopy/holmium laser lithotripsy: cost and outcome analysis. J Urol, 2009, 182(3): 1012-1017.
7. Akman T, Binbay M, Ozgor F, et al. Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2-4 cm stones: a matched-pair analysis. BJU Int, 2012, 109(9): 1384-1389.
8. Akman T, Binbay M, Ugurlu M, et al. Outcomes of retrograde intrarenal surgery compared with percutaneous nephrolithotomy in elderly patients with moderate-size kidney stones: a matched-pair analysis. J Endourol, 2012, 26(6): 625-629.
9. Bozkurt OF, Resorlu B, Yildiz Y, et al. Retrograde intrarenal surgery versus percutaneous nephrolithotomy in the management of lower-pole renal stones with a diameter of 15 to 20 mm. J Endourol, 2011, 25(7): 1131-1135.
10. Knoll T, Jessen JP, Honeck P, et al. Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10-30 mm size. World J Urol, 2011, 29(6): 755-759.
11. Chung BI, Aron M, Hegarty NJ, et al. Ureteroscopic versus percutaneous treatment for medium-size (1-2-cm) renal calculi. J Endourol, 2008, 22(2): 343-346.
12. 高小峰, 周铁, 陈书尚, 等. 输尿管软镜碎石与微创经皮肾取石术治疗肾盏结石的对比研究. 中华腔镜泌尿外科杂志, 2007, 1(2): 69-72.
13. 施小东, 程跃, 邱中笑, 等. 电子输尿管软镜碎石术治疗肾结石疗效观察. 现代实用医学, 2012, 22(9): 1018-1019.
14. Okhunov Z, Friedlander JI, George AK, et al. STONE Nephrolithometry: Novel Surgical Classification System for Kidney Calculi. Urology, 2013, 21(8): 659-694.
15. Yili L, Yongzhi L, Ning L, et al. Flexible ureteroscopy and holmium laser lithotripsy for treatment of upper urinary tract calculi in patients with autosomal dominant polycystic kidney disease. Urol Res, 2012, 40(1): 87-91.
16. Falahatkar S, Khosropanah I, Allahkhah A, et al. Open surgery, laparoscopic surgery, or transureteral lithotripsy—which method? Comparison of ureteral stone management outcomes. Journal of Endourology, 2011, 25(1): 31-34.
17. Agarwal M, Agrawal MS, Jaiswal A, et al. Safety and efficacy of ultrasonography as an adjunct to fluoroscopy for renal access in percutaneous nephrolithotomy (PCNL). BJU International, 2011, 108(8): 1346-1349.
18. Multescu R, Geavlete B, Georgescu D, et al. Conventional fiberoptic flexible ureteroscope versus fourth generation digital flexible ureteroscope: A critical comparison. J Endourol, 2010, 24(1): 17-21.
19. Perlmutter AE, Talug C, Tarry WF, et al. Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis. Urology, 2008, 71(2): 214-217.
20. Molimard B, Al-Qahtani S, Lakmichi A, et al. Flexible ureterorenoscopy with holmium laser in horseshoe kidneys. Urology, 2010, 76(6): 1334-1337.
21. El-Nahas AR, Ibrahim HM, Youssef RF, et al. Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for treatment of lower pole stones of 10-20 mm. BJU Int, 2012, 110(6): 898-902.
22. 马建伟, 程跃. 输尿管软镜治疗上尿路结石新进展. 临床泌尿外科杂志, 2012, 27(5): 398-400.
23. Rippel CA, Nikkel L, Lin YK, et al. Residual fragments following ureteroscopic lithotripsy: incidence and predictors on postoperative computerized tomography. J Urol, 2012, 188(6): 2246-2251.

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of Flexible Ureteroscope Lithtripsy and Percutaneous Nephrolithotomy for Renal Calculus: A Systematic Review

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