The Meta Analysis Of Treating Kidney Stones By Flexible Ureteroscopic Lithotripsy And Percutaneous Nephrolithotomy

Objective:To evaluate the efficacy and safety of FURL and PCNL in the treatment of kidney stones,and provide reference for clinical work.Methods: After searching the search strategy,we searched for forward-looking or retrospective research published in Chinese and English.From January 1,2008 to the present,we searched for the treatment of kidney stones using FURL or PCNL.After the literature was processed by two people according to the standard,Meta analysis was performed using Revman5.3provided by Cochrane.Results:A total of 19 studies were included,including 2,093 patients.(1)The stone-free rate of the FURL group was lower than that of the PCNL group[OR=0.44,95% CI(0.33,0.58),P<0.00001].Subgroup analyses were performed on stones <2 cm,>2 cm.The results showed that there was no statistical difference between the two treatments in the <2 cm stone-free rate[OR=0.66,95% CI(0.43,1.02),P=0.06].When the stones were >2cm,the stone-free rate in the FURL group was lower than that in the PCNL group[OR=0.31,95% CI(0.21,0.46),P<0.00001].(2)The incidence of complications in the FURL group was lower than in the PCNL group[OR=0.40,95% CI(0.25,0.64),P=0.0001].(3)The decrease in hemoglobin was lower in the FURL group than in the PCNL group [MD=-1.41,95% CI(-1.58,-1.24),P<0.00001].(4)The operation time of the FURL group was greater than that of the PCNL group [MD=15.89,95% CI(6.30,25.47),P=0.001].The subgroup analysis was performed on stones <2cm,>2cm.The results showed that there was no significant difference in the operation time of the two treatments with <2cm stones [MD = 6.44,95% CI(-5.41,18.30),P =0.29 ].However,in the treatment of >2cm stones,the operation time in theFURL group was greater than in the PCNL group [MD=24.26,95%CI(15.30,33.23),P<0.00001].(5)The postoperative length of stay in the FURL group was less than in the PCNL group [MD=-2.49,95%CI(-3.37,-1.61),P<0.00001].Conclusions:FURL has a similar stone-free rate and operative time as PCNL in treating <2 cm of kidney stones,but it has a significant advantage over PCNL in the incidence of complications,hemoglobin drop,and postoperative hospital stay.PCNL has the advantages of high stone-free rate and short operation time in the treatment of larger kidney stones >2cm,and the treatment effect is relatively thorough,but the complication rate is higher than FURL.