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Efficacy and safety of the surgical treatments for lower calyceal stones: A systematic review and network meta-analysis

Int J Surg. 2023 Mar 4. doi: 10.1097/JS9.0000000000000062. Online ahead of print.


OBJECTIVE: Efficacy and safety of 5 common surgical treatments for lower calyceal (LC) stones were assessed for LC stones≤20 mm.

METHODS: A systematic literature search was conducted up to June 2020 using PUBMED, EMBASE and Cochrane Library. The study has been registered in PROSPERO, CRD42021228404. Randomized controlled trials evaluating efficacy and safety of 5 common surgical treatments for LC stones were collected, including percutaneous nephrolithotomy (PCNL), MiniPCNL (MPCNL), UltraminiPCNL (UMPCNL), extracorporeal shock wave lithotripsy (SWL) and retrograde intrarenal surgery (RIRS). Heterogeneity among studies was assessed by using the global inconsistency and local inconsistency. Both pooled Odds ratio (OR) along with 95% credible interval (CI) and the surface under the cumulative ranking curve (SUCRA) values, were calculated to assess the outcomes, paired comparisons of efficacy and safety of 5 treatments.

RESULTS: 9 peer-reviewed RCTs, comprising 1674 patients, in recent 10 years, were included. Heterogeneity tests showed no statistical significance, and a consistency model was chosen, respectively. The order of SUCRA values for efficacy was as follows: PCNL (79.4), MPCNL (75.2), UMPCNL (66.3), RIRS (29), and SWL (0). For safety: SWL (84.2), UMPCNL (82.2), RIRS (52.9), MPCNL (16.6) and PCNL (14.1).

CONCLUSION: In the current study, all 5 treatments are both effective and safe. Many factors must be considered to choose surgical treatments for LC stones≤20 mm; the results that we separate conventional PCNL into PCNL, MPCNL and UMPCNL make the questions even more controversial. However, relative judgements are still needed to be used as reference data in clinical managements. For efficacy, PCNL>MPCNL>UMPCNL>RIRS>SWL, SWL is statistically inferior to other 4 treatments, respectively. RIRS is statistically inferior to PCNL and MPCNL, respectively. For safety, SWL>UMPCNL>RIRS>MPCNL>PCNL, SWL is statistically superior to RIRS, MPCNL and PCNL, respectively. RIRS is statistically superior to PCNL. We cannot reach conclusions which surgical treatment is the best choice for all patients with LC stones≤20 mm; Therefore, tailored treatments based on individual patients still demand more attention than ever before for both patients and urologists.

PMID:36906759 | DOI:10.1097/JS9.0000000000000062

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