LIU Wei 1,2,3 # , YANG Enguang 1,2,3 # , GAO Dongyang 1,2,3 , PANG Yangyang 1,2,3 , TIAN Jinhui 4,5,6 , GUO Qi 1,2,3 , GONG Yuwen 1,2,3 , LI Diyin 1,2,3 , ZHANG Tao 1,2,3 , WANG Yuhan 1,2,3 , WANG Zhiping 1,2,3
  • 1. Institute of Urology, the Second Hospital, Lanzhou University, Lanzhou, 730030, P.R.China;
  • 2. Key Laboratory of Gansu Province for Urological Diseases, Lanzhou, 730030, P.R.China;
  • 3. Gansu Nephro-Urological Clinical Center, Lanzhou, 730030, P.R.China;
  • 4. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, P.R.China;
  • 5. Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, P.R.China;
  • 6. Chinese GRADE Center, Lanzhou University, Lanzhou, 730000, P.R.China;
WANG Zhiping, Email: erywzp@lzu.edu.cn
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ObjectivesTo systematically review the efficacy and safety of laparoscopic pyelolithotomy (LP) versus percutaneous nephrolithotomy (PNL) in treating large (>2 cm) renal pelvic calculi.MethodsDatabases including PubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI and WanFang Data were searched for relevant randomized controlled trials (RCTs) comparing LP with PNL for the treatment of large renal pelvic calculi from inception to September 23th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of eligible studies. Meta-analysis was then performed by using RevMan 5.2 software.ResultsFive RCTs with 447 patients were included. The results of meta-analysis showed that: compared with PNL group, LP group provided a significantly higher stone-free rate (RR=1.07, 95%CI 1.01 to 1.13, P=0.01), lower auxiliary procedure rate (RR=0.36, 95%CI 0.13 to 1.01, P=0.05), less hemoglobin decrease (MD=–0.83, 95%CI –1.05 to –0.61, P<0.000 01) and lower postoperative fever rate (RR=0.36, 95%CI 0.18 to 0.72,P=0.004). However, no significant differences were detected in conversion rate (RR=0.76, 95%CI 0.19 to 3.07, P=0.70), blood transfusion rate (RR=0.40, 95%CI 0.14, to 1.12, P=0.08), postoperative leakage rate (RR=1.87, 95%CI 0.67 to 5.21, P=0.23), operative time (MD=10.49, 95%CI –17.14 to 38.13, P=0.46) and hospital stay (MD=0.53, 95%CI –0.22 to 1.28, P=0.17).ConclusionsLP is superior to PNL with regard to stone-free rate, auxiliary procedure rate, hemoglobin decrease and postoperative fever rate. Due to limited quality and quantity of included studies, more high quality studies are required to verify above conclusions.

Citation: LIU Wei, YANG Enguang, GAO Dongyang, PANG Yangyang, TIAN Jinhui, GUO Qi, GONG Yuwen, LI Diyin, ZHANG Tao, WANG Yuhan, WANG Zhiping. Efficacy and safety of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in large renal pelvic calculi: a meta-analysis . Chinese Journal of Evidence-Based Medicine, 2018, 18(9): 947-952. doi: 10.7507/1672-2531.201711120 Copy

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