Percutaneous nephrolithotomy versus retrograde intrarenal surgery for pediatric patients with upper urinary stones: a systematic review and meta-analysis

The objective of this study is to compare the efficacy and safety of the percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in surgical treatment of pediatric patients with upper urinary stones based on the published literature. A comprehensive literature search of Pubmed, Embase, Cochrane Library and CNKI was conducted to identify studies comparing outcomes of PCNL and RIRS for treating pediatric patients with upper urinary stones before May 2017. A total of 11 studies, including one randomized controlled trial, four retrospective case-control studies and six case series studies, containing 822 children with upper urinary stones were included in this systematic review. Five of 11 including studies, containing 474 children with upper urinary stones were included in a meta-analysis. Significantly shorter hospital stay and fluoroscopy time were needed by RIRS than PCNL (WMD: 1.44days, 95% CI 0.85, 2.04; p<0.00001) and (WMD: 72.72s, 95% CI 52.13, 93.31; p<0.00001). The overall complications were higher for PCNL compared with RIRS (OR 1.70, 95% CI 1.02, 2.84; p=0.04). However, the minor (Clavien I or II) and major (Clavien III-V) complications rates in the PCNL group were higher compared with RIRS group but the differences were not statistically significant, respectively (p>0.05). RIRS also benefits from significantly less need for blood transfusion (OR 9.09, 95% CI 1.66, 49.78; p=0.01). No significant differences were found in initial, final stone-free rate, and operative times (p>0.05). Our analysis suggested that RIRS turns out to be a safe and feasible procedure alternative to PCNL for children with upper urinary stones in selected cases. Because of the inherent limitations of the included studies, further large sample, prospective, multi-centric and randomized control trials should be undertaken to confirm our findings.