Retrograde Intrarenal Surgery Versus Percutaneous Nephrolithotomy for Treatment of Renal Stones >2 Cm: a Meta-analysis

Objective: To systematically review the efficacy and safety of retrograde intrarenal surgery (RIRS) versus percutaneous nephrolithotomy (PCNL) for the treatment of renal calculi >2 cm.

Methods: We searched PubMed, Cochrane Library, Embase and the Chinese Biomedical Literature Database about RIRS and PCNL for the treatment of renal stones. The retrieval time ended in December 2013. All clinical trials were retrieved and their included references investigated. Two reviewers independently assessed the quality of all included studies, and the eligible studies were included and analyzed using the RevMan 5.2 software.

Results: Two randomized controlled trials and six clinical controlled trials were included, involving a total of 590 patients. Our meta-analysis showed that there were not significant differences in stone-free rate (relative risk [RR] = 0.95, 95% confidence interval (CI) 0.88-1.02, p = 0.11) and fever (RR = 0.95, 95% CI 0.54-1.67, p = 0.85) between RIRS and PCNL. We found that hospital stay (weighted mean difference [WMD] = -2.10, 95% CI -3.08 to -1.11, p < 0.10) and bleeding (RR = 0.20, 95% CI 0.06-0.68, p = 0.01) were lower and operation time was longer (WMD = 19.11, 95% CI 7.83-30.39, p < 0.10) for RIRS.

Conclusion: RIRS is a safe and effective procedure. It can successfully treat patients with stones >2 cm with a high stone-free rate and significantly reduce hospital stay without increasing complications. RIRS can be used as an alternative treatment to PCNL in selected cases with larger renal stones. However, further randomized trials are needed to confirm these findings.