Category: Endoscopic

MP21-2 - Evaluation of the surgical outcome SWL, mini-PCNL and RIRS for the management of lower pole stones with a size <2cm stones: a systematic review and meta-analysis

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

Introduction and objectives:  We aim to compare the surgical outcomes of SWL, RIRS and mini-PCNL for the treatment of lower pole stones with a size

Methods :

The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Several databases were searched including PubMed, Scopus, Cochrane, Embase, WOS without language restriction. Only comparative prospective studies were evaluated. Not randomized studies or studies not describing the location of the renal stones were excluded. The primary end point was the stone free rate at 1 and 3 months. Secondary end points included operative time, days of hospitalization, retreatment rate and complications. Statistical meta-analyses was performed with the RevMan 5.3.5 software.

Results :

In all, 6687 publications were identified after the initial search, from which 18 randomized controlled trials (RCTs) were included in the systematic review. The stone free rate at three months was higher with mini-PCNL compared with either RIRS or SWL with odds ratios (OD) of 1,54 (95% confidence interval [CI]: 0,70, 3,39; I2=0%) and 0,09 (95% CI: 0,04, 0,22; I2=0%) respectively. Comparing RIRS and SWL the stone free rate at three months was higher with RIRS with OD of 3,17 (95% CI: 2,34, 4,29; I2=52%). Favorable results in terms of operative time were observed in the case of SWL with mean differences (MD) of 48,56 (95% CI: 51,77, 45,35; I2=not applicable) compared with mini-PCNL and 7,58 (95% CI: 8,13, 7,02; I2=100%) compared with RIRS. Comparing mini-PCNL and RIRS, RIRS had smaller operative time with MD of 31,42 (95% CI: 36,68, 26,15; I2=96%). Hospitalization time was favorable in case of SWL with MD of 1,65 (95% CI: 1,73, 1,57; I2=Not applicable) compared with mini-PCNL and 1,18 (95% CI: 1,12, 1,24; I2=not applicable) compared with RIRS. RIRS had more favorable results compared with mini-PCNL with MD of 0,50 (95% CI: 0,17, 1,17; I2=Not applicable). In case of retreatment rate, mini-PCNL had the most favorable results with OD of 0,15 (95% CI: 0,01, 3,77; I2=not applicable) compared with RIRS and 28,57 (95% CI: 7,63, 106,93; I2=0%) compared with SWL.  Comparing SWL and RIRS, RIRS had more favorable result with OD of 0,05 (95% CI: 0,03, 0,08; I2=54%).

Conclusions :

This meta-analysis showed a significant higher stone free rate at 3 months and retreatment rate for mini-PCNL in comparison with RIRS and SWL. Operative and hospitalization time favored SWL and RIRS over mini-PCNL.

Panagiotis Kallidonis

assistant professor of surgery
Department of Urology, University of Patras, Patras, Greece
Patras, Akhaia, Greece

Dimitrios Kotsiris

Urologist, PhD candidate
Department of Urology,University of Patras,Patras,Greece
Patras, Akhaia, Greece

My name is Dimitrios Kotsiris, MD,PhD candidate, FEBU and I am a Urologist since June 2018. I graduated the Medical School of the University of Thessaloniki and the Military school of Medical corps in 2010. I am an officer in the Hellenic Navy (Lieutenant). I worked as a doctor in the Naval Hospital of Athens and Crete. My training in Urology in Greece started in February 2014 in the Naval Hospital of Athens. I continued my education in the Department of Urology of Sismanoglion University Hospital in Athens and continued in the Department of Urology of the University of Patras since April 2016. I am a phD candidate and my research interests include the fields of endourology, laparoscopic surgery and urolithiasis.

Constantinos Adamou

Department of Urology,University of Patras,Patras,Greece
Patras, Akhaia, Greece

Panteleimon Ntasiotis

Department of Urology,University of Patras,Patras,Greece
Patras, Akhaia, Greece

Evangelos Liatsikos

Professor of surgery
Department of Urology,University of Patras,Patras,Greece
Patras, Akhaia, Greece

Dr Evangelos Liatsikos is the Chairman of the European Association of Urology Section of Uro- Technology (ESUT). He is a Professor of Urology at the University of Patras in Greece. He is a Guest Professor at the University of Leipzig in Germany and Adjunct Professor at the Medical University of Vienna, Austria. He is distinguished in literature for his research in Laparoscopy and Endourology, with his work accounting for more than 260 international publications. Dr. Liatsikos has also been invited as a speaker and live surgeon in a series of the most prestigious urological congresses worldwide. For his scientific contribution, Professor Liatsikos was nominated for the “Arthur Smith Endourology Lectureship” award in 2009 by the World Association of Endourology. He received the award of “Academic Endourology Fellowship Program Director” on November 2016 during the World Congress of Urology.

Thomas O. Tailly

Consultant Urologist
University Hospital Ghent
Gent, Oost-Vlaanderen, Belgium

Thomas Tailly graduated as a medical doctor from the Catholic University Leuven, Belgium in 2007. He went on to complete his urology residency training in 2013 in Belgium at the same institution, where he developed a special interest in urolithiasis in all its aspects and minimally invasive treatment modalities of both benign and malignant pathologies. As a resident he seated on multiple boards of national urological organisations and was active in the European Society of Residents in Urology. After completing an Endourology Fellowship in London, Ontario, at Western University under the supervision of Dr. John Denstedt, Dr. Stephen Pautler and Dr. Hassan Razvi, he took a position as consultant urologist in the University Hospital of Ghent in Belgium. During his fellowship he finished a Master of Science degree in Surgery, with a special interest in urological stent and catheter design, biomaterial and coatings. Apart from his clinical work as the primary stone surgeon of the hospital, he is currently involved in both clinical and translational research on urolithiasis and its diagnostic and treatment modalities.

Zakaria ISSA. Saki

Endourology fellow
Department of Urology,University of Patras,Patras,Greece
Patras, Akhaia, Greece

Endourology and Laparoscopic Surgery Fellow.
Department of Urology,University of Patras,Patras,Greece
Patras, Akhaia, Greece