Percutaneous Nephrolithotomy In The Oblique Supine Lithotomy Versus Prone Position:A Meta-Analysis

Objective: To systematically review the efficacy and safety of percutaneous nephrolithotomy(PCN)in the oblique supine lithotomy position(OSLP)versus prone position(PP).Methods: The PubMed,Medline,Embase,Web of Science,Cochrane Central Register of Controlled Trials,CNKI,WanFang,VIP databases were searched up to January 2017 to collect the literatures of controlled trials about percutaneous nephrolithotomy in the oblique supine lithotomy position versus prone position.Manual searching other related magazines,such as Chinese Journal of Urology,Journal of Modern Urology,Journal of Clinical Urology and China Journal of Endoscopy.Extracted the data and assessed the quality of included literatures independently performed by two authors according to the method of Cochrane systematic review.RevMan 5.2 software was used to make data analysis.Results: 12 randomized controlled trials,3 controlled clinical trails and6 retrospective control studies involving 2013 patients were included.The baseline of each trail were comparable.Meta analysis showed:(1)The influence of respiratory and circulatory system: For non high risk patients,compared with the PP group,the OSLP group had a less impact on systolic blood pressure(p=0.0006)and airway pressure(p<0.0001).There were no significant differences(p>0.05)between the PP and OSLP groups on diastolic blood pressure,heart rate and oxygen saturation.For high risk patients(Age?65y,BMI?28 kg/m~2,ASA II-III),compared with the PP group,the OSLP group had a less impact on heart rate(p=0.001),systolic blood pressure(p<0.00001)and oxygen saturation(p=0.03).There were no significant differences between the PP and OSLP groups on diastolic blood pressure(p=0.14).(2)Effectiveness: Compared with the PP group,the OSLP group had shorter operative time(p<0.00001).But there were no significant differences between the PP and OSLP groups on the time of establishing tunnel(p=0.62),stone free rate(p=0.14),and duration of hospital stay(p=0.44).(3)Safety:There were no statistical difference between two groups on the total incidence of complications(p=0.09).Although OSLP groups had less blood loss(p=0.003).There were no statistical difference between two groups on the the transfusion(p=0.44),postoperative hemorrhage(p=0.80),fever(p=0.96),urinary leakage(p=0.70),sepsis(p=0.50),renal injury(p=0.24),colon injury(p=0.23)and pleural effusion(p=0.66).Conclusion: Compared with the PP group,the OSLP group had a less impact on the respiratory and circulatory system.It's of very wide application.Oblique supine lithotomy position in the elderly obese patients' PCN has the more advantages over the prone position.Both two position PCN are safe and effective.And PCN in Oblique supine lithotomy position is better than in prone in operative time.It also can be improved the stone free rate by PCN combined with ureteroscopelithtripsy.Although OSLP groups had less blood loss.Both two position PCN are safe and effective.However,because of the limitation of the literature,more high quality and larger sample RCTs with rigorous design are needed.