Comparison of safety and efficacy between single-tract and multiple-tract percutaneous nephrolithotomy treatment of complex renal calculi: a systematic review and meta-analysis.

Abstract

A systematic review and meta-analysis was conducted to explore the safety and efficacy of single-tract and multiple-tract percutaneous nephrolithotomy (PCNL) in complex renal calculi treatment. PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases (updated November 2020) were searched for studies assessing the effect of different numbers of tracts on cases that underwent PCNL. The search strategy and study selection process were managed according to the PRISMA statement. Five comparative studies were included in the meta-analysis. The multiple-tract PCNL group had a significantly increased total complications rate than the single-tract group (OR=2.35, 95% CI=1.71, 3.25; P<0.00001) with insignificant heterogeneity (I2=0%, P=0.52). Subgroup analysis showed there were different incidence of complications, mainly because the multiple-tract PCNL group was significantly associated with a higher rate of blood transfusion (OR=2.99, 95% CI=1.95, 4.57; P<0.00001) with insignificant heterogeneity (I2=9%, P=0.35). There were no differences in operation time (MD=12.04, 95% CI=6.36, 17.72; P<0.0001) or hospitalization (MD=0.54, 95% CI=0.14, 0.95, P=0.008). However, the single-tract group had a higher stone-free rate (OR=0.37, 95% CI=0.19, 0.74; P=0.005) with heterogeneity (I2=51%, P=0.08), as stones in the single-tract group were smaller than those in the multiple-tract group. The current research did not find that the multiple-tract group had a higher stone-free rate. Additionally, multiple-tract PCNL was associated with a higher incidence of blood transfusion and negative impact on renal function.