Tract Sizes in Miniaturized Percutaneous Nephrolithotomy: A Systematic Review from the European Association of Urology Urolithiasis Guidelines Panel
Abstract
Context: Miniaturized instruments for percutaneous nephrolithotomy (PNL), utilizing tracts sized 22 Fr). Objective: We systematically reviewed all available evidence on the efficacy and safety of miniaturized PNL for removing renal calculi.
Evidence acquisition: The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Since it was not possible to perform a meta-analysis, the data were summarized in a narrative synthesis.
Evidence synthesis: After screening 2945 abstracts, 18 studies were included (two randomized controlled trials [RCTs], six nonrandomized comparative studies, and 10 case series). Thirteen studies were full-text articles and five were only available as congress abstracts.
The size of tracts used in miniaturized procedures ranged from 22 Fr to 4.8 Fr. The largest mean stone size treated using small instruments was 980 mm2.
Stone-free rates were comparable in miniaturized and standard PNL procedures. Procedures performed with small instruments tended to be associated with significantly lower blood loss, while the procedure duration tended to be significantly longer.
Other complications were not notably different between PNL types. Study designs and populations were heterogeneous.
Study limitations included selection and outcome reporting bias, as well as a lack of information on relevant confounding factors.