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META-ANALYSIS OF THE COMPLICATIONS OF PERCUATNEOUS NEPHROLITHOTOMY: COMPARISON OF PROCEDURES AND TECHNIQUES
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META-ANALYSIS OF THE COMPLICATIONS OF PERCUATNEOUS NEPHROLITHOTOMY: COMPARISON OF PROCEDURES AND TECHNIQUES
Sutchin R. Patel, M.D., Dean Leocadio, M.D., George Haleblian, M.D., August Zabbo, M.D., Gyan Pareek, M.D.
Division of Urology, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Background: We performed a meta-analysis of the literature to define the complications associated with percutaneous nephrolithotomy (PNL).
Methods: References were searched in the MEDLINE database from 1997 to 2007 using the terms "complications" and "percutaneous nephrolithotomy." Inclusion criteria included any study with greater than 20 patients, patient age older than 18 years and any complications listed for PNL. Procedures included in the study were unilateral tubed, synchronous bilateral and tubeless PNL. A data extraction form was created to categorize major and minor complications. A four member panel reviewed all of the studies that were extracted, data was entered into a spreadsheet and a meta-analysis performed. Unilateral tubed PNL was used as the standard procedure to which all other procedures were compared.
Results: Of the 95 references from our literature search, 64 met our study inclusion criteria. A total of 4967 patients and 5736 renal units were included in the meta-analysis. The overall major and minor complication rates for PNL were 15.7% and 7.8% respectively. Tubeless PNL (583 patients) had a comparable major complication rate (17.8% vs 15.5%, p>0.05) and a significantly lower minor complication rate (4.0% vs. 8.3%, p<0.05) compared to tubed PNL. Synchronous bilateral PNL (374 patients) had a lower major complication rate (6.4% vs 15.5%, p<0.05) and a comparable minor complication rate (6.4% vs 8.3%, p>0.05) compared to unilateral tubed PNL. The transfusion rate for tubeless, tubed and synchronous bilateral PNL were 4.4%, 6.3% and 7.8% (p>0.05). The mean hospital stay per patient was significantly lower for patients undergoing tubeless PNL (2.6 days) compared to tubed and synchronous bilateral PNL patients (4.6 and 4.7 days respectively) (p<0.05).
Conclusions: Our results show that patients who undergo PNL may have an overall major complication rate of 15.7%. Tubeless PNL has a comparable major complication rate and a lower minor complication rate when compared to tubed PNL. Synchronous bilateral PNL has a lower major complication rate and a comparable minor complication rate compared to unilateral tubed PNL. The differences in complication rates between tubed unilateral PNL, tubeless and synchronous bilateral PNL may be due to intraoperative patient selection and stone burden.
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