Comparison of Efficacy and Safety of Five Categories of Intracorporeal Lithotripsy Devices in Percutaneous Nephrolithotomy: A Systematic Review and Network Meta-Analysis of Randomised Control Trials.

Objective: To evaluate the effectiveness of the ultrasonic lithotriptor compared to the combined ultrasonic-pneumatic lithotriptor in percutaneous nephrolithotomy (PCNL). Material & Methods: A systematic search was conducted focusing on studies evaluating nephrolithiasis patients who underwent PCNL using pneumatic, ultrasonic, ultrasonic-pneumatic, or laser lithotriptor. The search was conducted in the PUBMED and Science-direct databases from early to September 2020. Results: There were 406 journals in the initial search. On further selection, 3 randomized controlled trials (RCT) were obtained, with a total of 251 patients. The stone-free rate of three studies had low heterogeneity, I2=0% (P=0.34), so a fixed effect statistical model was used. There was no significant difference (P=0.44) between the stone-free rates from the ultrasonic lithotriptor group and the combination with an odds ratio of 1.26 (95% CI = 0.70-2.26). High heterogeneity was obtained with I2=71% (P=0.03) for the mean fragmentation time, so random effect statistical model was used. There was no significant difference (P=0.56) between the mean fragmentation time of the ultrasonic lithotriptor and combination group with a mean difference of -3.69 (95% CI = -16.09-8.71). Conclusion: The ultrasonic lithotriptor did not have a significant difference in stone-free rate, and mean fragmentation time compared to the combined ultrasonic-pneumatic lithotriptor in PCNL. More RCT studies are needed.

Background of the study: Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for kidney stones larger than 2 cm. PCNL has replaced open surgical removal of large or complex calculi at the most institutions. The success of PCNL is related to the ability to achieve an optimum access tract and proper fragmentation. A wide range of lithotripsy techniques are currently available. One of these is ultrasonic lithotripsy, in which the stones are fragmented and sucked out simultaneously. This technique induces minimal tissue injury and could be considered as a standard modality for PCNL. The pneumatic lithotripter uses pneumatic ballast, which crushes the stones without producing any thermal effects. Because this mechanical energy passes along the metal wire to the stone, the probe works like a chisel on the stone surface. This modality destroys all stones, regardless of their composition. There were very few studies had been done in this context in our country, so I had decided to do this study to compare the outcome of stone fragmentation with pneumatic and ultrasonic lithotripter during percutaneous nephrolithotomy. Objective: To compare the outcome of stone fragmentation with pneumatic and ultrasonic lithotripter during percutaneous nephrolithotomy. Materials & Methods: This Prospective Interventional Study (Quasi Experimental Trial) was performed in Department of Urology, National Institute of Kidney Diseases and Urology, Sher-E- Bangla Nagar, Dhaka during the period from December 2014 to May 2016. A total of 60 subjects will be selected with renal calculi (as per inclusion & exclusion criteria), among these, half of the patients will be group A (using pneumatic lithotripsy) & rest of the patients will be group B (using ultrasonic lithotripsy). The study subjects were underwent PCNL under general anesthesia, half of which used pneumatic lithotripter and rest used ultrasonic lithotripter for stone fragmentation. Above mentioned outcome variables were assessed both per-operative and post-operatively. Data were collected, processed & analyzed. Statistical analysis of relevant variables was done by unpaired Student’s T test and Chi Square test. P value Â0.05 was considered significant. Results: Total 60 patients were selected for study according to the selection criteria. Of the 60 subjects, 30 patients, those who were done PCNL by pneumatic lithotripsy were labeled as Group A and 30 patients, those who were done PCNL by ultrasonic lithotripsy, were labeled with Group B. Distribution of respondents in terms of different parameters is shown in tabulated form and statistical analysis was done in both groups to see statistical significance, p value less than 0.05 was considered significant. The mean stone fragmentation time was 27.23±4.78 (18-38) min in PCNL by pneumatic lithotripsy and those were 23.80±5.30 (13-34) min in by ultrasonic lithotripsy which is statistically significant. Other variables of interest which includes stone clearance rate, post operative haematuria and post operative hospital stay, were not statistically significant. Conclusion: Comparing the findings of the present study, results indicate that stone fragmentation time is lesser in ultrasonic lithotripsy than pneumatic lithotripsy in PCNL which decreases the overall operative time. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.129-135

Objectives To evaluate the methods and efficacy of percutaneous nephrolithotomy with ultrasonic and pneumatic lithotripter(EMS Ⅳ)in the treating of complicated renal calcali.Methods 512 renal unites with complicated renal ealeali received percutaneous nephrolithotomy performed by ultrasonic and pneumatic lithotripter.Results 89.5%stone-free rate wan achieved one-stage minimally invasive percutaneous nephrolithotomy.Average opcrative time was 115 minutes.Neither the pheumothorax nor the bowel hurts complications were noted in the patients.Conclusions Invasive percutaneous nephrolithotomy is safe and effective in the treatment of major renal calcalli.High stone free rate,less invasion easy recovery and shot hospitalization stay are its merits.It also has advantages of treating the patients with residual calculi. Key words: Kidney Calculi; Lithotripsy; Endoscopy

Objective To compare the safety and efficacy between flexible ureteroscope lithtripsy (FURL) and percutaneous nephrolithotomy (PCNL) in treating the renal calculus.Methods From Jan.2012 to Oct.2013,120 male and 87 female patients with renal calculus were accepted FURL (n =108)or PCNL (n=99) in our hospital.In FURL group,108 cases were classified according to the diameter of the stone,including 33 patients with the diameter of renal stone more than 20mm (range 20-39 mm,mean 29.2±5.6 mm)and 75 patients with the diameter of renal stone less than 20 mm (range 13-19 mm,mean 16.8± 1.3 mm).In PCNL group,99 cases were also classified according to the diameter of the stone,including 51 patients with the diameter of renal stone more than 20 mm (range 20-45 mm,mean 30.4±6.6 mm)and 48 patients with the diameter of renal stone less than 20 mm (range 14-19 mm,mean 17.2±1.4mm).There were no significant differences between the groups FURL and PCNL in the stone size(P＞0.05).Demographic data,operative duration,postoperative hospital stay,complication rate,and stone-free rate were recorded and compared.Results The overall stone free rate in group FURL was significantly lower 80.6％ (87/108) than that in group PCNL 91.9％ (91/99) (P＜0.05).In those patients with the diameter of stones less than 20 mm,the stone free rate was 88.0％ (66/75) in group FURL vs 93.8％ (45/48) in group PCNL (P＞0.05).The operative time was 30-65 (mean 49.5±6.9) min and 30-65 (mean 46.9±7.2) min in FURL and PCNL group,respectively (P＞0.05).In those patients with the diameter of stones more than 20 mm,the stone free rate was 63.6％ (21/33) in group FURL,which was lower than that in group PCNL 90.2％ (46/51) (P＜0.05).The operative time was 60-115 min (85.0±16.3) min and 30-95 min (68.3± 16.7) min in FURL and PCNL group,respectively (P＜0.05).The overall complication rate was significantly lower in group FURL 2.8％ (3/108) compared to group PCNL 8.1％ (8/99) (P＜0.05).Postoperative hospitalization stay were 2-6 d (3.5±1.4) d and 3-9 d (5.8±1.9) d in FURL and PCNL group,respectively (P＜0.05).Conclusions Both PCNL and FURS are efficacy and safe surgical alteration for patients with renal calculus.As to the FURS,its merits were faster recovery,less invasiveness than those in PCNL.Therefore,it can be considered as the first-line treatment for renal calculus ＜20 mm.However,for renal calculus ≥20 mm stones,FURS is still effective. Key words: Renal calculus; Flexible ureteroscope; Percutaneous nephrolithotomy; Safety; Effectivity

Objectives. To compare the effectiveness and safety of ultrasonic and pneumatic lithotripters in the treatment of renal stone disease. Materials and Methods. A total of 227 consecutive percutaneous nephrolithotomy procedures for renal calculi were performed. In 107 patients ultrasonic lithotriptors were used (group I) and in 83 patients pneumatic lithotriptors were used (group II). In the remaining 37 patients, stones were managed with both pneumatic and ultrasonic lithotripters. Follow-up studies included intravenous urography (IVU) and/or computed tomography (CT). Results. The mean operative time and duration of hospitalization were similar between the groups. In the ultrasonic treatment group, 100 (96.9%) patients were stone-free on postoperative day 1 and 5 (4.6%) went on to undergo an additional treatment modality, resulting in a total stone-free rate of 97.2%. In the pneumatic lithotripsy group, 68 (81.9%) patients were stone-free after the primary procedure on the first day and 15 (18.1%) went on to undergo an additional treatment modality, resulting in a stone-free rate of 91.5%. The final stone-free rates at 3 months postoperatively in groups I, II, and III were 97.2%, 91.5%, and 87.9%, respectively (P = 0.826). Conclusions. We conclude that both ultrasonic and pneumatic lithotripters are effective and safe for intracorporeal lithotripsy. However, the ultrasonic lithotripter provides higher stone-free rates with similar morbidity compared with pneumatic devices.

Background/Aims: Renal calculi, or kidney stones, are masses made of crystals that affect people of all geographical, cultural, and racial groups. We conduct this study with the aim of comparing the efficacy of various surgical methods in the treatment of renal calculi. Methods: Controlled clinical trials (CCTs) related to different surgical treatment approaches for renal calculi were included in this study by retrieving them from electronic English databases. The odds ratios (OR), the weighted mean difference (WMD), 95% confidence intervals (95% CI) and surface under the cumulative ranking curves (SUCRA) were evaluated, followed by a cluster analysis. Results: Compared with the extracorporeal shockwave lithotripsy (SWL), minimally invasive percutaneous nephrolithotomy (mini-PCNL), retrograde intrarenal surgery (RIRS), standard percutaneous nephrolithotomy (standard PCNL), ureterorenoscopy (URS) and micro-percutaneous nephrolithotomy (microperc) regimens, the open anatrophic nephrolithotomy (Open AN), URS + RIRS and laparoscopic pyelolithotomy (LP) surgical procedures all presented with a higher stone-free rate in renal calculi. Lower auxiliary procedures were found in the URS + RIRS treatment approach compared with SWL, RIRS, URS and microperc regimens. In addition, the SWL regimen indicated a lower stone-free rate than the mini-PCNL, standard PCNL, Open AN, URS + RIRS and LP regimens. Finally, the RIRS regimen presented with the shortest in-patient stay compared to the mini-PCNL, standard PCNL, Open AN, URS, URS + RIRS and LP regimens. Conclusion: This meta-analysis demonstrated that the URS + RIRS surgical procedure has the best stone-free rate and the lowest number of auxiliary procedures. The RIRS and Microperc both have the shortest hospital stay and operative time.

PD19-01 COMPARISON OF A NOVEL COMBINED HOLMIUM LASER AND SUCTION DEVICE, LITHASSIST, TO AN ULTRASONIC LITHOTRIPTER FOR PERCUTANEOUS NEPHROLITHOTOMY- A RANDOMIZED CONTROLLED MULTICENTER CLINICAL TRIAL

We prospectively randomized total 29 patients with renal stones into two groups between Aug 2014 and March 2016. The US group was treated using a ultrasonic lithotripter (Swiss LithoClast® Master) and the PN group was treated with a pneumatic lithotripter (Swiss LithoClast® ). We compared treatment outcomes in these groups. The US group consisted of 17 patients and the PN group 12 patients. There was no significant difference between the groups in baseline characteristics (age, sex, body mass index, side, stone size, and density). There was no significant difference in total operative time (p＝0.63), stone-free rate (p＝ 0.19), hemoglobin deficit (p＝0.49), or rate of postoperative sepsis (p＝0.99) between the two groups. However, intracorporal stone disintegration and removal time was significantly shorter in the US group than the PN group (p＝0.029). These results suggest that the ultrasonic lithotripter can be superior to the existing pneumatic lithotripter in saving intracorporal stone disintegration and removal time in percutaneous nephrolithotomy.

Clinical Trials of the Surgical Management of Urolithiasis: Current Status and Future Needs

Nephrolithiasis is a highly prevalent urological condition, necessitating effective and minimally invasive treatment strategies. Percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) are commonly employed for managing renal calculi, but their comparative efficacy and safety remain subjects of ongoing debate. This meta-analysis aims to synthesize current evidence, providing a comprehensive assessment of surgical outcomes between PCNL and RIRS for renal stones under 2cm and greater than 2cm, reported across different study designs, various surgical techniques, and different geographical distributions to guide clinical decision-making. A systematic literature search was conducted across electronic databases, including PubMed, Embase, Scopus, Cochrane, and Clinicaltrials.gov, up to December 2024. Risk of Bias assessment was conducted using the Newcastle-Ottawa Scale for non-randomized cohort studies and the Cochrane Risk of Bias 2.0 (RoB 2.0) tool for RCTs. Data extraction focused on key outcomes such as stone-free rate, complications, operation time, hospital stay, and the need for blood transfusions. Statistical analysis utilized a random-effects model to pool data, with heterogeneity assessed using the I2 statistic and publication bias evaluated via funnel plots. The analysis of 62 studies (25 were RCTs and 37 were cohorts) with 7021 patients revealed a significantly higher stone-free rate in the PCNL group compared to RIRS (RR: 1.06, 95% CI [1.04, 1.09], p < 0.00001), indicating greater efficacy in stone clearance. However, PCNL was associated with a significantly higher risk of complications (RR: 1.49, 95% CI [1.25, 1.77], p < 0.00001) and a greater need for blood transfusions (RR: 3.20, 95% CI [1.70, 6.03], p = 0.0003), associated with increased risk. Post-operative hematuria was marginally higher in the PCNL group (RR: 2.06, 95% CI [1.01, 4.19], p = 0.05). Among the PCNL techniques, all PCNL techniques showed significantly higher Hb drop; micro-PCNL was associated with the smallest hemoglobin drop relative to RIRS (MD = 0.62, 95% CI 0.38 to 0.86), followed by mini-PCNL and standard-PCNL. Operation times were comparable between the two procedures, but PCNL resulted in a significantly longer hospital stay (MD: 1.73, 95% CI [1.35, 2.10], p < 0.00001). PCNL demonstrates a superior stone-free rate for renal stones under 2cm and greater than 2cm, but this is accompanied by a higher risk of complications and a longer hospital stay compared to RIRS. RIRS offers a safer alternative with fewer complications and shorter hospital stays, making it a viable option for at-risk patients. The use of miniaturized PCNL techniques appears to mitigate some of the complication risks associated with traditional PCNL, potentially offering a balance between efficacy and safety. Clinical decision-making should be individualized, considering patient and stone characteristics, surgeon experience, and the availability of advanced PCNL techniques.

Tranexamic acid for percutaneous nephrolithotomy.

PD13-09 MICRO VERSUS MINI PERCUTANEOUS NEPHROLITHOTOMY FOR THE TREATMENT OF PEDIATRIC KIDNEY STONE DISEASE

Comparative efficacy, acceptability, and tolerability of adjunctive anti-inflammatory agents on bipolar disorder: A systemic review and network meta-analysis.

Systematic Review on the Learning Curve of Percutaneous Nephrolithotomy: Operative Time, Fluoroscopy Time, Stone-free Rate, Puncture Performance, Complications, and Safety Indicators.

Various new positions for percutaneous nephrolithotomy (PCNL) were proposed to reduce the limitations of the traditional position. This study was aimed to evaluate the efficacy and safety of the different PCNL positions. PubMed, Embase, Web of Science, and the Cochrane Library were searched for relevant randomized controlled trials (RCTs) up to 18 April 2023. The authors collected five common surgical positions used for PCNL: oblique supine position (OSP), supine position (SP), flank position (FP), split-leg oblique supine/flank position (SLP), and prone position (PP). Paired and network meta-analysis were conducted to compare relevant outcomes, including complications, operative time, stone-free rates, hospital stay, and hemoglobin loss among these different positions. The study included 17 RCTs with a total of 1841 patients. The result demonstrated that SLP significantly outperformed in terms of decreasing operation time (FP vs SLP MD- MD-41.65; OSP vs SLP MD 28.97; PP vs SLP MD 34.94), hospital stay, and hemoglobin loss. Ranking probabilities showed SLP had highest stone-free rate. Prone position was more likely to occur complications than others. Based on SMAA model, the benefit-risk analysis suggested the SLP was the optimal position in PCNL. For PCNL, the split-leg, flank, supine, and OSPs are as secure as the prone position. Further RCTs are necessary to confirm the outstanding safety and efficacy of split-leg position. Besides, the position should be selected regard for the patient's demands, the surgeon's preference and learning curve.