Abstract
Objective To assess current evidence on the effectiveness and safety of single- versus multiple-tract percutaneous nephrolithotomy in the surgical management of complex caliceal calculi or staghorn stones through a comprehensive literature review. Methods A comprehensive literature review of articles investigating the clinical efficacy and safety of single- versus multiple-tract percutaneous nephrolithotomy was performed. Relevant literature was obtained by systematically searching PubMed, EMBASE, and the Cochrane Library through May 2020. We followed the search strategy based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The primary outcomes, including the stone-free rate (SFR), and secondary outcomes (peri- and postoperative complications and operative data) were evaluated using RevMan 5.3 statistical software. Results Ten studies involving 1844 patients with complex caliceal calculi or staghorn stones met the inclusion criteria. Single-tract percutaneous nephrolithotomy (STPCNL) had noninferior clinical efficacy with respect to the immediate SFR (odds ratio (OR) = 0.80, 95% confidence interval (CI) (0.46 to 1.38), p = 0.42) and 3-month SFR (OR = 1.22, 95% CI (0.38 to 3.92), p = 0.74) compared with multiple-tract percutaneous nephrolithotomy (MTPCNL). In addition, pooled analyses showed that STPCNL resulted in significantly lower hemoglobin decreases (MD = −0.46, 95% CI (-0.68 to -0.25), p < 0.0001), fewer blood transfusions (OR = 0.48, 95% CI (0.34 to 0.67), p < 0.0001), and fewer pulmonary complications (OR = 0.28, 95% CI (0.09 to 0.83), p = 0.02) than MTPCNL. However, the overall evidence was insufficient to suggest a statistically significant difference for other adverse events. Conclusion This meta-analysis indicated that STPCNL is an effective method for treating complex caliceal calculi or staghorn stones. Compared with MTPCNL, STPCNL not only yields similarly high SFRs but also is associated with many advantages, less blood loss, fewer blood transfusions, and fewer pulmonary complications without an increase in other complications. However, the findings of this study should be further confirmed by well-designed prospective randomized controlled trials (RCTs) with a larger patient series.
Highlights
Ureteral calculi represent a common disease that seriously endangers life and work for more than 12% of the population
We considered the definition of staghorn calculi to be stones that branched and occupied a large portion of the collecting system, such as complete staghorn stones or partial staghorn stones, and we defined complex caliceal calculi as those with a large bulk and involving more than one calix, the upper ureter, or both
Ten studies focusing on two different complex caliceal calculus or staghorn stone interventions were included, which involved 1844 participants, 48.26% (n = 890) of whom underwent Single-tract percutaneous nephrolithotomy (STPCNL), while 51.73% (n = 954) underwent multiple-tract percutaneous nephrolithotomy (MTPCNL)
Summary
Ureteral calculi represent a common disease that seriously endangers life and work for more than 12% of the population. For patients with staghorn or complex caliceal calculi, the goal of treatment is to achieve maximal clearance of stones and assure maximal renal function preservation with minimal complications. Complex caliceal and staghorn stones are difficult to remove with a single-tract PCNL approach [3]. A trend toward the use of percutaneous monotherapy using multiple tracts as the preferred treatment option for most staghorn or complex calculi has emerged [4]. A concern with creating multiple percutaneous tracts is the potential risks of greater bleeding and higher complication rates compared with the single-tract approach [5]. Conducting a new systematic review and metaanalysis that includes relevant available studies evaluating the efficacy of single- versus multiple-tract PCNL in the surgical management of complex caliceal calculi or staghorn stones is worthwhile
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