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Minerva Urology and Nephrology 2022 April;74(2):169-77

DOI: 10.23736/S2724-6051.21.04587-0


language: English

The fight between PCNL, laparoscopic and robotic pyelolithotomy: do we have a winner? A systematic review and meta-analysis

Guglielmo MANTICA 1, 2, Federica BALZARINI 1 , Francesco CHIERIGO 1, Etienne X. KELLER 3, 4, Michele TALSO 4, 5, Esteban EMILIANI 4, 6, Amelia PIETROPAOLO 4, 7, Rocco PAPALIA 8, Roberto M. SCARPA 8, Carlo TERRONE 1, Francesco ESPERTO 2, 4, 8, European Society of Residents in Urology (ESRU) and Young Academic Urologists (YAU) 

1 Department of Urology, IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy; 2 European Society of Residents in Urology - ESRU, Arnhem, the Netherlands; 3 Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; 4 Young Academic Urologists - YAU, Urolithiasis and Endourology Working Party, Arnhem, the Netherlands; 5 Department of Urology, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy; 6 Unit of Endourology and Urolithiasis, Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain; 7 Department of Urology, University Hospital of Southampton, Southampton, UK; 8 Department of Urology, Campus Bio-Medico University, Rome, Italy

INTRODUCTION: The aim of this systematic review and meta-analysis was to provide an updated comparison between the currently available minimally invasive approaches (PCNL, laparoscopic [LP] and robotic pyelolithotomy [RP]) for the management of large renal stones.
EVIDENCE ACQUISITION: An electronic search of the current literature was conducted through the Medline and NCBI PubMed, Embase, Scopus and Cochrane Collaboration Central Register of Controlled Clinical Trials databases in March 2021. Studies about minimally-invasive treatment for kidney stones were considered. Inclusion criteria were: studies evaluating patients with large renal calculi (≥2 cm); the comparison of at least two of the three approaches (PCNL, LP, RP), and reporting data suitable for meta-analysis evaluation. Patients with concomitant management for ureteropelvic junction obstruction (UPJ-O) were excluded.
EVIDENCE SYNTHESIS: Overall, 17 reports were considered for qualitative and quantitative synthesis, for a total cohort of 1079 patients, of which 534 with PCNL, 525 treated with LP, and 20 with RP. Of those, 16 compared PCNL with LP, while only 1 study compared LP with RP. PCNL mean operative time was statistically significantly shorter than LP and RP while mean estimated blood loss was statistically significantly higher for PNCL. No statistically significant differences were recorded among the three surgical approaches. Finally, PCNL demonstrated slightly, albeit statistically significant lower stone free rate when compared with LP.
CONCLUSIONS: PCNL, LP and RP may be safely and efficiently used to manage large renal stones. All three procedures showed reasonably low rate of complications with a satisfactory stone clearance rate.

KEY WORDS: Kidney calculi; Nephrolithotomy, percutaneous; Urology

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