Laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of large renal pelvic calculi (diameter >2 cm): a meta-analysis

Objective: To systematically assess the efficacy and safety of laparoscopic pyelolithotomy (LP) versus percutaneous nephrolithotomy (PCNL) for the treatment of renal pelvic calculi >2 cm.

Methods: We searched PubMed, Embase, Cochrane Library, and Google Scholar about LP and PCNL for the treatment of renal stones. The retrieval time ended in September 2015. Two reviewers independently assessed the quality of all included studies. The available data in the studies were analyzed using the RevMan 5.2 software.

Results: Four randomized controlled trials (RCTs) and nine Non-Randomized Concurrent Controlled Trials (NRCCTs) were included, involving a total of 766 patients. This meta-analysis showed that LP has a statistically higher stone-free rate than PCNL [I² = 0, OR = 0.26 (95% CI 0.10-0.64), p = 0.003], lower drop in hemoglobin level [I² = 0, difference in mean drop = -0.83 (95% CI -1.05 to -0.61), p < 0.00001] and lower postoperation fever [I² = 0, OR = 0.36 (95% CI 0.14-0.89), p = 0.03], and PCNL is associated with a lower length of hospital stay [I² = 74%, difference in mean of hospital stay = 0.72 (95% CI 0.04-1.40), p = 0.04].

Conclusion: LP is an alternative for the treatment of large solitary renal stone. LP may have a higher stone-free rate, lesser blood loss, lower postoperation fever rate, while PCNL may have a lower length of hospital stay. However, further well designed and large volume randomized controlled trials are needed to confirm these findings.