Micropercutaneous versus Retrograde Intrarenal Surgery for the Management of Moderately Sized Kidney Stones: A Systematic Review and Meta-Analysis

Introduction: To compare the effect of micropercutaneous surgery (microperc) and retrograde intrarenal surgery (RIRS) in the management of moderately size kidney stones. Methods: A systematic literature search was conducted in March 2019 using PubMed, Google Scholar, Web of Science, Embase, the Cochrane Library, and Medline to identify relevant studies. A subgroup analysis was performed to compare microperc with RIRS in patients with lower-pole stones (LPS) and non-LPS (NLPS), respectively. Results: Three randomized controlled trials (RCTs) and 4 non-RCTs were analyzed. Microperc provided a significantly lower rate of double-J stent insertion (p < 0.00001) but a larger decrease in hemoglobin levels (p = 0.0002). In contrast, RIRS led to a shorter hospital stay (p = 0.01) and a lower stone-free rate (SFR) (p = 0.03). IN the subgroup analysis, RIRS provided a significantly lower drop in hemoglobin drop than microperc in patients with LPSs (p = 0.0003). Microperc showed a longer operative time (p = 0.03), longer hospital stay (p = 0.04), and greater drop in hemoglobin (p = 0.04) in patients with NLPS. Conclusions: Microperc is associated with fewer double-J stent insertions and higher SFR at the expense of a greater drop in hemoglobin and longer hospital stay. Given the differences between the procedures, urologists should synthesize the individual characteristics of patients and unique advantages of these therapies so as to choose the optimal treatment for individual patients.