Efficacy and safety of ultrasound- vs fluoroscopy-guided percutaneous nephrolithotomy in managing renal calculi: A systematic review and meta-analysis of randomized controlled trials.

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY Urology Pub Date : 2024-11-17 DOI:10.1016/j.urology.2024.11.025

Ruoyang Du, Wubing Feng, Tong Yi

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Abstract

Objective: To evaluate the effectiveness and safety of ultrasound-guided percutaneous nephrolithotomy (UG-PCNL) compared to fluoroscopy-guided PCNL (FG-PCNL) for kidney stone management, focusing on clinical outcomes and procedural efficiency.

Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following PRISMA guidelines. Searches were performed in PubMed, EMBASE, Scopus, and Web of Science for studies published between 2000 and 2024. Primary outcomes included stone-free rate (SFR), needle puncture time (NPT), calculus clearance rate (CCR), and access time. Secondary outcomes involved single needle puncture success rate (SNPSR), hospital stay duration (HSD), total complication rate (TCR), urosepsis, fever and postoperative serum creatinine.

Results: Analysis of 21 RCTs with 2969 patients showed no significant difference in SFR between UG-PCNL and FG-PCNL (OR: 0.93, 95% CI: 0.77-1.13; p = 0.47). UG-PCNL significantly reduced access time (SMD: 0.68, 95% CI: 0.06-1.30; p = 0.03), while other outcomes like SNPSR and puncture time showed no significant differences. Complication rates, including urosepsis and fever, were comparable between techniques.

Conclusions: UG-PCNL is as effective as FG-PCNL, offering the benefits of radiation-free imaging and reduced access time, with comparable safety profiles. Further studies are needed to confirm the certainty of outcomes like SNPSR and bleeding rates.

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超声与透视引导下经皮肾镜取石术治疗肾结石的有效性和安全性：随机对照试验的系统回顾和荟萃分析。

目的评估超声引导下经皮肾镜取石术（UG-PCNL）与透视引导下经皮肾镜取石术（FG-PCNL）在肾结石治疗中的有效性和安全性，重点关注临床结果和手术效率：按照 PRISMA 指南对随机对照试验 (RCT) 进行了系统回顾和荟萃分析。在 PubMed、EMBASE、Scopus 和 Web of Science 中检索了 2000 年至 2024 年间发表的研究。主要结果包括无结石率（SFR）、针刺时间（NPT）、结石清除率（CCR）和穿刺时间。次要结果包括单针穿刺成功率（SNPSR）、住院时间（HSD）、总并发症发生率（TCR）、尿崩症、发热和术后血清肌酐：对 21 项研究、2969 名患者进行的分析表明，UG-PCNL 和 FG-PCNL 的 SFR 无明显差异（OR：0.93，95% CI：0.77-1.13；P = 0.47）。UG-PCNL 明显缩短了入路时间（SMD：0.68，95% CI：0.06-1.30；p = 0.03），而 SNPSR 和穿刺时间等其他结果则无明显差异。尿毒症和发热等并发症的发生率在不同技术之间不相上下：结论：UG-PCNL 与 FG-PCNL 同样有效，具有无辐射成像和缩短穿刺时间的优点，而且安全性相当。需要进一步的研究来确认 SNPSR 和出血率等结果的确定性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Urology 医学-泌尿学与肾脏学

CiteScore

3.30

自引率

9.50%

发文量

716

审稿时长

59 days

期刊介绍： Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.