Rice P. et al., 2021: Percutaneous laser nephrolithotripsy: is it here to stay? Results of a systematic review
Rice P, Somani BK.
Department of Urology, University Hospitals Southampton.
Department of Urology, University of Southampton, Southampton, UK.
Purpose of review: PCNL (percutaneous nephrolithotomy) and its miniaturized variants are being widely employed in stone surgery, owing to their high-stone-free rates (SFRs) and efficacy for large (>20 mm) stones. With advances in laser technology, it has been readily utilized in PCNL, with the potential for lower complication rates at similar SFR. We aimed to perform a systematic literature review with a focus on recent prospective clinical data that compares laser PCNL to either nonlaser PCNL, different PCNL sizes or other current standards of care such as shockwave lithotripsy (ESWL) or flexible ureteroscopy (FURS).
Recent findings: Of the 294 studies initially identified through database searching, nine papers published between 2019 and 2021 were included which compared laser PCNL (Standard PCNL in three, mini-PCNL in four, ultra-mini PCNL in one, micro-PCNL in one study) to other nonlaser lithotripsy, ESWL, FURS, and different PCNL sizes. Complications for laser PCNL ranged from bleeding (4.4%), perirenal haematoma (1.1%), fever (4.6%), ureteric/renal pelvic injury (2.3%), haematuria (2.7%), and infection (2.6%). The mean SFR for laser PCNL was 91.5% at 3 months.
Summary: Percutaneous laser nephrolithotripsy is well tolerated and effective, with high-SFRs at 3 months and relatively low intraoperative and postoperative complication rates. Further research is required to assess the role of intraoperative techniques and suction to improve outcomes further.
Curr Opin Urol. 2021 Dec 20. doi: 10.1097/MOU.0000000000000959. Online ahead of print. PMID: 34930884
The article summarizes a systematic review of what can be accomplished with PCNL compared with other stone-disintegrating treatment modalities. Undoubtedly, there has been a pronounced development of PCNL-technology, based on miniaturization and laser disintegration.
To understand the recent achievements the following definition of different PCNL-techniques is given:
Standard PCNL 20-24Fr
Micro-PCNL smaller than 10Fr
Although 294 article dealt with modern PCNL (mini or micro), only nine articles provided basis for the analysis, eight of which were RCTs.
Below I have extracted some relevant information on stone-free treatments from the report:
The overall success with percutaneous procedures as extracted from Table 2 in the article amounts to 85.1%. There is insufficient information on how SWL was carried out. That information is necessary for understanding the SFR in these studies. Most certainly more care was devoted to the invasive procedures. But it is concluded in the report that additional studies are necessary to define how PCNL should be carried out. How to improve SWL was not the purpose of the study and moreover the small number of SWL-treated patients does not allow for any general conclusions. So, from an SWL point of view this report is of little or no interest.