Comparison of vacuum-assisted sheaths and normal sheaths in minimally invasive percutaneous nephrolithotomy: a systematic review and meta-analysis

Ling Zhu,Ye Zhou,Xiaofeng Zheng,Yan Huang,Zhenghao Wang,Liping Gou

doi:10.1186/s12894-021-00925-1

Abstract

BackgroundA systematic review and meta-analysis was conducted to compare the safety and efficacy of vacuum-assisted sheaths and conventional sheaths in minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of nephrolithiasis.MethodsPubMed, Web of Science, Embase, EBSCO, and Cochrane Library databases (updated March 2021) were used to search for studies assessing the effect of vacuum-assisted sheaths in patients who underwent MPCNL. The search strategy and study selection processes were implemented in accordance with the PRISMA statement.ResultThree randomized controlled trials and two case-controlled trials that satisfied the inclusion criteria were enrolled in this meta-analysis. Overall, the stone-free rate (SFR) in patients who underwent vacuum-assisted sheaths was significantly higher than that in patients who underwent conventional sheaths (RR 1.23, 95% CI 1.04, 1.46, P = 0.02), with significant heterogeneity among the studies (I2 = 72%, P = 0.03). In terms of the outcome of complications, vacuum-assisted sheath could bring a benefit to the postoperative infection rate (RR 0.48, 95% CI 0.33, 0.70, P < 0.00001) with insignificant heterogeneity among the studies (I2 = 0%, P = 0.68). There was no significant difference in the blood transfusion rate (RR 0.35, 95% CI 0.07, 1.73, P = 0.17), with significant heterogeneity (I2 = 66%, P = 0.35). Three studies contained operative time data, and the results indicated that the vacuum-assisted sheath led to a shorter operative time (MD = − 15.74; 95% CI − 1944, − 12.04, P < 0.00001) with insignificant heterogeneity (I2 = 0%, P = 0.91).ConclusionThe application of a vacuum-assisted sheath in MPCNL improves the safety and efficiency compared to the conventional sheath. A vacuum-assisted sheath significantly increases the SFR while reducing operative time and postoperative infection.

Highlights

A systematic review and meta-analysis was conducted to compare the safety and efficacy of vacuumassisted sheaths and conventional sheaths in minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of nephrolithiasis
The application of a vacuum-assisted sheath in MPCNL improves the safety and efficiency compared to the conventional sheath
Primary outcomes Stone‐free rate All studies included for the analysis reported the stone-free rate (SFR), where stone-free was defined as stone fragments ≤ 4 mm (1 study using computed tomography (CT) scan and 2

Summary

Introduction

A systematic review and meta-analysis was conducted to compare the safety and efficacy of vacuumassisted sheaths and conventional sheaths in minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of nephrolithiasis. Urolithiasis is the third most common disease of the urinary tract, and its prevalence has increased over the past decades [1]. The prevalence rate of kidney stones worldwide is approximately 1.7% to 8.8%, and kidney stones cost approximately $2.1 billion in 2020 alone [2]. For renal stones > 2 cm in size, the American Urological Association recommends percutaneous nephrolithotomy (PCNL) as the primary treatment [4]. Previous studies have shown that standard PCNL is a highly effective approach [5]. It is often associated with major complications such as bleeding with the need for blood transfusion, postoperative fever, and pneumothorax [6]

Methods

Findings

Discussion

Conclusion