Percutaneous nephrolithotomy with concurrent negative pressure aspiration for renal calculus: a systematic review and meta-analysis

Abstract

Objective To compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) with or without concurrent aspiration in the treatment of renal calculus. Methods We systematically searched PubMed, EMBASE, the Cochrane Controlled Trial Register of Controlled Trials, CNKI, Wanfang, and Chinese Biological Medical Database for randomized controlled trials comparing PCNL with or without aspiration in adult patients with renal calculus. Study quality was assessed by the criteria outlined in the Cochrane Handbook for Systematic Reviews of intervention. Meta-analysis was performed by Reviewer Manager Software, Version 5.3. Results Twelve trials with 1 100 patients met the inclusion criteria and were entered into the final analysis. Our pooled analysis showed that PCNL with concurrent aspiration could reduce surgical duration [MD=-10.03; 95%CI(-15.79, -4.27), P=0.0006], postoperative fever [RR=0.41, 95%CI(0.27, 0.61), P<0.001], hemorrhage [MD=-71.63, 95%CI(-136.89, -6.37), P=0.03], Total clavien complication rate [RR=0.54; 95%CI(0.41, 0.71); P<0.001], Clavien Grade II complication rate [RR=0.43, 95%CI(0.30, 0.60), P<0.001], and renal pelvic pressure [MD=-10.47, 95%CI(-11. 49, -9.45), P<0.001]. It could also enhance the stone-free rate [RR=1.11, 95%CI(1.00, 1.23), P=0.05]. However, there was no difference with respect to septic shock [RR=0.43, 95%CI(0.12, 1.63), P=0.22], Clavien Grade I complications [RR=0.83, 95%CI(0.47, 1.48), P=0.53] and Clavien Grade III and above complications [RR=1.12, 95%CI (0.40, 3.15), P=0.83]. Conclusions Compared to PCNL without suction, this meta-analysis shows that PCNL with concurrent aspiration results in a significantly higher stone-free rate and a decrease in surgical duration, fever occurrence, hemorrhage, Clavien total complications, Clavien Grade II complications, and renal pelvic pressure, without an increase in the incidence of septic shock, Clavien Grade I, III and above complications. Key words: Renal calculus; Percutaneous nephrolithotomy; Aspiration; Meta-analysis