Laparoscopic Pyelolithotomy Compared with Percutaneous Nephrolithotomy in Surgical Management of Large Renal Pelvic Calculi: A Meta-analysis

Abstract

Purpose

To assess the effectiveness and safety of laparoscopic pyelolithotomy (LP) compared with percutaneous nephrolithotomy ( PCNL) in surgical management of solitary renal pelvic calculi larger than 2cm.

Materials and Methods

We searched PubMed, EMBASE, Cochrane Library, and the ISI Web of Knowledge databases up to November 9, 2012 for the relevant published studies. After data extraction and quality assessment, meta-analysis was performed using the RevMan 5.1 software.

Results

Seven trials with 176 patients undergoing LP and 187 undergoing PCNL were identified. Operative time and length of hospital stay were shorter in the PCNL group by 50.62 min (p < 0.0001) and 0.66 d (p = 0.04), respectively. But patients in LP group might benefit from fewer drop in hemoglobin level (OR -1.00, 95% CI -1.77 to -0.23), less postoperative fever (OR 0.24, 95% CI 0.08-0.72), lower incidence of bleeding (OR 0.29, 95% CI 0.10-0.85), and higher stone-free rate (OR 4.85, 95% CI 1.59-14.82). Sensitivity analysis indicated that all the results were stable except the result of stone-free rate demonstrated no significant statistic difference between the two groups (OR 0.33, 95% CI 0.09-1.17). There was no publication bias detected.

Conclusions

Current evidence suggests that LP and PCNL are both effective and safe for treatment of large renal pelvic calculus, and LP seems to be more advantageous. However, given the inherent limitations of the included studies, the results need to be further confirmed by high quality randomized controlled trials.

http://www.jurology.com/article/S0022-5347(13)00368-6/abstract