Effectiveness And Safety Of Flexible Ureteroscope And 10~14Fr Sized Percutaneous Nephrolithotomy For Patients With Renal Calculus (About 2cm In Diameter):A Meta Analysis

Objective:To evaluate the effectiveness and safety of flexible ureteroscope and Super/Ultra-mini Percutaneous nephrolithotomy for patients with renal calculus(about 2cm in diameter)by the means of meta analysis.Methods:By searching Pubmed,Ovid,Springer,The Cochrane Library,CNKI,Wanfang Database and VIP,we comprehensively collected literatures on clinical controlled trials of flexible ureteroscope and SMP or UMP in the treatment of renal calculi of about 2 cm.Two investigators independently conducted literature screening,data extraction,and quality assessment of the included literature,using RevMan 5.3 software for meta-analysis.Result:A total of 7 articles and 657 patients were included.The results of meta analysis showed that the stone free rate in 1 month postoperative was higher in the percutaneous nephrolithotomy group than in flexible ureteroscope group [OR=3.08,95% CI(1.29,7.34),P=0.01],the operation time was shorter than that of flexible ureteroscope [MD =-13.12,95% CI(-19.48,-6.75),P<0.0001].However,FURS was better than UMP or SMP in postoperative hospital stay [MD=0.74,95% CI(0.20,1.28),P= 0.007],postoperative mean hemoglobin drop [MD=4.99,95% CI(2.2,7.78),P<0.0005] as well as Visual Analogue Score(VAS)[MD=0.88,95% CI(0.01,1.76),P=0.05].No significant difference in postoperative total complications rate [OR=1.21,95% CI(0.68,2.14),P=0.52],postoperative fever [OR=0.79,95% CI(0.42,1.49),P=0.47],Procalcitonin level [MD= 0.20,95% CI(-0.79,1.19),P= 0.69] or severe postoperative complications(Clavien Grade III)[OR = 2.35,95% CI(0.83,6.66),P = 0.11].Conclusions:For the treatment of renal stones with a diameter of about 2cm,10~14Fr sized Percutaneous nephrolithotomy(SMP/UMP)is superior to Flexible Ureteroscope in terms of stone clearance rate and operation time.Whereas in terms of postoperative hospital stays,hemoglobin drop and post-operation pain,flexible ureteroscope are more effective.