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Ultrasound-guided versus fluoroscopy-guided percutaneous nephrolithotomy: a systematic review and meta-analysis

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Abstract

Purpose

To evaluate the efficacy and safety of ultrasound-guided (UG) versus fluoroscopy-guided (FG) percutaneous nephrolithotomy (PCNL).

Methods

A systematic search of PubMed (MEDLINE), Embase, and the Cochrane Library was conducted to identify randomized controlled trials that compared UG-PCNL with FG-PCNL, and a meta-analysis of those studies was completed. The primary outcomes assessed were stone-free rate (SFR) and complication rate. Secondary outcomes assessed were the successful access-creation rate, time necessary for entrance into the target calyx, auxiliary procedure rate, transfusion rate, hemoglobin decrease after surgery, surgery duration, and hospital stay.

Results

Eight studies comprising 966 patients were included in the meta-analysis. Compared with FG-PCNL, UG-PCNL had comparable stone-free rates [odds ratio (OR) 0.95; 95% confidence interval (CI) 0.67–1.35; p = 0.79] irrespective of the patient’s position, and a favorable safety profile resulting in a lower complication rate (OR 0.56; 95% CI 0.36–0.86; p = 0.009). No statistical difference was found between UG and FG groups in secondary outcomes.

Conclusions

UG-PCNL is as effective as FG-PCNL and has the advantage of lower complication rates. In addition, UG-PCNL could be performed with patients in the supine position without compromising its efficacy.

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Acknowledgements

The authors would like to thank the Department of Medical Education in Wanfang Hospital for facilitating the research and Enago (http://www.enago.tw) for the English language review.

Author information

Authors and Affiliations

  1. School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Yu-Hsiang Yang

  2. Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Yu-Ching Wen

  3. Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    Yu-Ching Wen

  4. Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Kuan-Chou Chen

  5. Department of Urology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Kuan-Chou Chen

  6. Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, 250 Wuxing St., Taipei, 11031, Taiwan, ROC

    Chiehfeng Chen

  7. Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan

    Chiehfeng Chen

  8. Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    Chiehfeng Chen

  9. Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    Chiehfeng Chen

  10. Department of Medical education, Linkou Chang Gung Memorial Hospital, Taoyuan District, Taoyuan, Taiwan

    Yu-Hsiang Yang

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  1. Yu-Hsiang Yang
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  2. Yu-Ching Wen
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  3. Kuan-Chou Chen
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  4. Chiehfeng Chen
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Contributions

YHY and CC: literature search and the data extraction. YHY: protocol/project development, data, management, and manuscript writing. CC: protocol/project development, data analysis, and manuscript writing. YCW: protocol/project development and data analysis. KCC: protocol/project development and data analysis.

Corresponding author

Correspondence to Chiehfeng Chen.

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This article does not contain any studies using human participants or animals conducted by any of the authors.

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Yang, YH., Wen, YC., Chen, KC. et al. Ultrasound-guided versus fluoroscopy-guided percutaneous nephrolithotomy: a systematic review and meta-analysis. World J Urol 37, 777–788 (2019). https://doi.org/10.1007/s00345-018-2443-z

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  • DOI: https://doi.org/10.1007/s00345-018-2443-z

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