Background: Percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) are widely used for pediatric upper tract stones; however, comparisons of their clinical efficacies are needed.
Methods: Literature searches for relevant articles were performed using PubMed, the Cochrane Central Register of Controlled Trials, Embase and the China CNKI database. Study quality was assessed by Jadad and Newcastle-Ottawa Scales. Standard mean differences (SMDs) or odds ratios (OR), and 95% confidential intervals (95% CIs) were pooled for meta-analysis. In addition, data was evaluated the quality of the body of evidence by means of grading of recommendations assessment, development, and evaluation (GRADE).
Results: Data from 4 studies (231 PCNL, 212 RIRS cases) were analyzed. There was no significant difference in operation time (SMD: 1.39; 95% CIs: -0.049 to 2.82; P = .058), overall stone-free rate (OR: 3.72; 95% CIs: 0.55-25.22; P = .18), or complication rate (OR: 1.92; 95% CIs: 0.90-4.07; P = .091). PCNL cases had longer hospital stays (SMD: 1.22; 95% CIs: 0.95-1.50; P < .001), but showed a higher stone-free rate for stones greater than 20 mm (OR: 6.38; 95% CIs: 1.83-22.22; P = .004). For stones less than 20 mm, however, no significant difference between PCNL and RIRS was found (OR: 0.92; 95% CIs: 0.33-2.55; P = .87). The quality of evidence based on the GRADE system was low.
Conclusion: Results of our systematic review and meta-analysis suggest that, for the treatment of larger kidney stones (>20 mm) in pediatric patients, PCNL is a better option due to its higher stone-free rate, although RIRS may be associated with shorter hospital stays. A large-scale clinical trial is necessary to validate our findings.