Comparison of safety and efficacy of negative pressure aspiration assisted retrograde intrarenal surgery and traditional percutaneous nephrolithotomy in the treatment of upper urinary tract stones larger than 2 cm: a systematic review and meta-analysis
Abstract
Background: Percutaneous nephrolithotomy (PCNL) is widely regarded as the first-line treatment for upper urinary tract stones larger than 2 cm, as recommended by major urological associations. However, a growing body of research highlights the safety and effectiveness of retrograde intrarenal surgery (RIRS) for managing stones of this size in the upper urinary tract, especially with the advent of suction-assisted techniques in RIRS. This study aims to systematically evaluate the safety and efficacy of negative pressure aspiration-assisted RIRS (NPAA-RIRS) in comparison to traditional PCNL. Method: Eligible studies were found by searching the PubMed, Embase, Web of Science and the CNKI databases for relevant reports published until July 2024. Outcome measures included initial and final stone-free rate (SFR), secondary operation, operation time, hemoglobin level reduction, blood transfusion, interventional embolization, postoperative hospital stay, complications. The assessment of publication bias was conducted using a funnel plot. Ten studies from nine articles were included, involving 1259 patients. Results: NPAA-RIRS group showed lower hemoglobin level reduction (WMD = −1.31, 95% CI [−1.64, −0.99], P < 0.001), less blood transfusion (RR = 0.15, 95% CI [0.05, 0.50], P = 0.002), shorter postoperative hospital stay (WMD: −1.93, 95% CI [−2.54, −1.32], P < 0.001), lower Clavien-Dindo I–II complication rate (RR: 0.51, 95% CI [0.38, 0.67], P < 0.001), and lower overall…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,259 participants or records.
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