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Zhao FZ. et al., 2020: Comparison of efficacy and safety of minimally invasive procedures for 10-20 mm pediatric renal Stones-A bayesian network meta-analysis

Zhao FZ, Li J, Tang L, Li CM, Zhang Y, Wang WY, Chen N, Tian Y.J .
Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, PR China.

Abstract

Objective: To assess the efficacy and safety of various minimally invasive procedures for 10-20 mm pediatric renal stones by Bayesian network meta-analysis (NWA).

Methods: We searched clinical comparative trials published in Pubmed, Embase, Cochrane Library from inception to 12 April 2020. Two researchers evaluated the quality and extracted data individually. Data was analyzed using STATA and GEMYC R package.

Results: The overall network meta-analytic outcome of stone free rate (SFR) in a single session revealed that Retrograde Intrarenal Stone Surgery (RIRS), miniaturized percutaneous nephrolithotomy (mPCNL) and PCNL showed superiority to extracorporeal shockwave lithotripsy (ESWL). Statistical significance was not detected between any intervention from our pooled network analysis of complication rate. SMP was the most likely to ranking in first place to render stone free status, and it also showed the lowest risk possibility of complications. Mini-PCNL had longer operation time and hospitalization than ESWL. The global and loop inconsistency evaluation demonstrated a rather acceptable outcome apart from the comparisons of complication rate between two randomized control studies.

Discussion: Herein, the authors reviewed and explored the optimal management pattern for pediatric 10-20 mm renal stones. This NWA revealed RIRS and mPCNL could render higher SFR without increasing risk of complications compared with ESWL. Although SMP was deemed to be the best choice in our study, the limited source of study and sample size implied the results required to be further validated. In addition, there were still some problems requiring to be underlined for various surgical options.

Conclusions: ESWL was inferior to RIRS, mPCNL and PCNL for 10-20 mm pediatric renal stones, among which SMP might be the most ideal option associated with the least possibility of complications and the highest probability of stone clearance.

Pediatr Urol. 2020 Aug 28:S1477-5131(20)30509-X. doi: 10.1016/j.jpurol.2020.08.019. Online ahead of print.

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Commenti 1

Hans-Göran Tiselius il Venerdì, 20 Novembre 2020 00:00

This article is a summary of reports in the literature and a meta-analysis was carried out to determine the efficacy and safety of modern methods for stone removal.

The study focused on children with stones measuring 10-20 mm. The outcome variable was SFR after ONE session with SWL, RIRS, mini-PCNL, micro-PCNL, ultra-mini-PCNL and super-mini-PCNL (SMP). For the percutaneous procedures it might be of value to recall the dimension of the instruments:
Mini-PCNL 14-20 F
Micro-PCNL 4.8 F
Ultra-mini-PCNL 11-13 F
Super-mini-PCNL 12-14 F (dimension of the irrigation shield; nephroscope 4.5-6.5 F)

https://www.storzmedical.com/images/blog/Zhao_006.JPG

Although the SFR results of SWL was inferior to those of the other procedures, there was only a small difference between SWL and RIRS. The problem with SWL is a higher percentage of re-treatments required for optimal SFR, but this information is insufficiently reported in this study.

The child kidney is sensitive to trauma and that is an important aspect both for percutaneous procedures and SWL. Another aspect that deserves consideration is how resistant children’s ureters are to repeated ureteroscopies, but that is incompletely studied.

SWL is commonly carried out in children with good results. Passage of stones and fragments is easier than in adults and the major shortcoming is that SWL in children usually requires anesthesia.

Hans-Göran Tiselius

This article is a summary of reports in the literature and a meta-analysis was carried out to determine the efficacy and safety of modern methods for stone removal. The study focused on children with stones measuring 10-20 mm. The outcome variable was SFR after ONE session with SWL, RIRS, mini-PCNL, micro-PCNL, ultra-mini-PCNL and super-mini-PCNL (SMP). For the percutaneous procedures it might be of value to recall the dimension of the instruments: Mini-PCNL 14-20 F Micro-PCNL 4.8 F Ultra-mini-PCNL 11-13 F Super-mini-PCNL 12-14 F (dimension of the irrigation shield; nephroscope 4.5-6.5 F) [img]https://www.storzmedical.com/images/blog/Zhao_006.JPG[/img] Although the SFR results of SWL was inferior to those of the other procedures, there was only a small difference between SWL and RIRS. The problem with SWL is a higher percentage of re-treatments required for optimal SFR, but this information is insufficiently reported in this study. The child kidney is sensitive to trauma and that is an important aspect both for percutaneous procedures and SWL. Another aspect that deserves consideration is how resistant children’s ureters are to repeated ureteroscopies, but that is incompletely studied. SWL is commonly carried out in children with good results. Passage of stones and fragments is easier than in adults and the major shortcoming is that SWL in children usually requires anesthesia. Hans-Göran Tiselius
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Lunedì, 19 Aprile 2021

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