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Abstract
Background:Staghorn stones are mostly treated by percutaneous nephrolithotomy (PCNL), either with an upper-pole (UP) or non-upper (lower- or middle-) pole (NP) approach. NP access has a lower risk of bleeding and thoracic complications but may not be sufficient for complete stone clearance. UP access is advocated as the preferred approach, because of direct access to the collecting system. However, it is associated with a higher complications rate, including pneumothorax and hydrothorax, and a higher risk of bleeding. This meta-analysis aimed to describe the outcomes and safety of PCNL for staghorn stones using UP and NP approaches.Methods:A systematic literature review was conducted using several databases such as: PubMed; EBSCO; Science Direct; Cochrane and Google Scholar. Data from all selected articles were extracted by two independent reviewers. Relevant parameters explored using Review Manager V5.3.Results:Five comparative studies of staghorn stones involving 384 renal units were analyzed; 176 cases used the UP approach and 208 the NP approach. There was no significant difference in stone-free rate between these approaches, with 74.4% undergoing the UP approach and 71.1% the NP approach considered stone-free (OR: 1.55; 95% CI: 0.92-2.63; P=0.10). The rate of thoracic complications (hydrothorax and pneumothorax) did not differ significantly (OR: 3.14; 95% CI: 0.63-15.62; P=0.16). However, we noted that 5 of 176 patients that underwent the UP approach experienced thoracic complications. The incidence of post-procedural fever and sepsis is similar (OR: 1.18; 95% CI: 0.52-2.64; P=0.69). Neither post-procedural urine leakage (OR: 2.03; 95% CI: 0.70-5.85; P=0.19) nor requirement of blood transfusions (OR: 0.49; 95% CI: 0.14-1.76; P=0.27) differed significantly.Conclusion:PCNL with UP access for staghorn stone has a similar stone-free rate to the NP approach. Thoracic complication rate which was believed to be higher in the UP group is also deemed similar with NP access.
Highlights
Percutaneous nephrolithotomy (PCNL) remains the mainstay of treatment of all type of renal calculi, with high a success rate and stone-free rate (SFR)
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Studies comparing UP access percutaneous nephrolithotomy (PCNL) and lower pole (LP) access PCNL for complex and staghorn renal stones were assessed for further analysis
Summary
Percutaneous nephrolithotomy (PCNL) remains the mainstay of treatment of all type of renal calculi, with high a success rate and stone-free rate (SFR). UP access is believed to be associated with a higher complication rate, which is mainly related to thoracic and abdominal complications, when the puncture is done above the 11th rib We designed this meta-analysis to systematically describe the outcomes and complications of PCNL for staghorn stones in upper and non-upper pole (lower and middle) approach. UP access is advocated as the preferred approach, because of direct access to the collecting system It is associated with a higher complications rate, including pneumothorax and hydrothorax, and a higher risk of bleeding. This meta-analysis aimed to describe the outcomes and safety of PCNL for staghorn stones using UP and NP approaches.
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