Background Percutaneous nephrolithotomy (PCNL) is the first choice treatment of renal stones larger than 2 cm. We aimed to evaluate if lasers perform as equal as non-laser devices in patients with kidney stones candidate to PCNL. Materials and methods A comprehensive literature search was performed in MEDLINE via PubMed, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) to assess the differences in the perioperative course, incidence of postoperative complications, and stone free-rate (SFR) in patients with kidney stones undergoing laser versus non-laser PCNL in randomized studies. The incidences of complications were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and expressed as Risk Ratios (RR), 95% Confidence Intervals (CI), and p-values. Surgical time and length of stay were pooled using the inverse variance of the mean difference (MD) with a random effect, 95% CI, and p-values. Analyses were two-tailed, with a significance set at p ≤0.05. Results Six papers including 732 patients (311 patients undergoing holmium laser and 421 non-laser PCNL) were included in meta-analysis. Surgical time and postoperative stay were shorter in the non-laser group (MD:11.14, 95% CI:2.32-19.96, p=0.002; MD:-0.81, 95%CI:-2.18–0.57 p=0.25, respectively). SFR was significantly higher in the non-laser group (RR:1.08, 95% CI:1.01–1.15, p=0.03). Patients undergoing laser PCNL had a non-significant higher risk of postoperative fever >38°C (RR:0.64, 95%CI: .31–1.30, p=0.22). Transfusion rate did not differ between the two groups (RR:1.02, 95% CI:0.50-2.11 p=0.95). The need for stent positioning due to urine extravasation was higher risk in the laser group but the difference did not reach significance (RR:0.49, 95% CI:0.17-1.41 p=0.19). Conclusions Non-laser PCNL showed better perioperative outcomes and SFR as compared to holmium laser PCNL.

中文翻译：

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激光对经皮肾镜取石术结果的影响：随机比较试验的系统评价和荟萃分析结果

背景 经皮肾镜取石术 (PCNL) 是大于 2 cm 肾结石的首选治疗方法。我们的目的是评估激光在肾结石候选 PCNL 患者中的性能是否与非激光设备相同。材料和方法 通过 PubMed、Scopus 和 Cochrane 对照试验中心注册库 (CENTRAL) 在 MEDLINE 中进行了全面的文献检索，以评估围手术期、术后并发症发生率和结石游离率 (SFR) 患者的差异。随机研究中接受激光与非激光 PCNL 的肾结石。使用 Cochran-Mantel-Haenszel 方法和随机效应模型汇总并发症的发生率，并表示为风险比 (RR)、95% 置信区间 (CI) 和 p 值。使用具有随机效应的平均差 (MD) 的逆方差、95% CI 和 p 值汇总手术时间和住院时间。分析是双尾的，显着性设置为 p ≤0.05。结果 6 篇论文包括 732 例患者（311 例接受钬激光和 421 例非激光 PCNL）被纳入荟萃分析。非激光组的手术时间和术后住院时间较短（MD：11.14，95% CI：2.32-19.96，p=0.002；MD：-0.81，95%CI：-2.18-0.57 p=0.25）。非激光组的 SFR 显着更高（RR：1.08，95% CI：1.01-1.15，p=0.03）。接受激光 PCNL 的患者术后发热 > 38°C 的风险没有显着增加（RR：0.64，95%CI：0.31-1.30，p=0.22）。两组之间的输血率没有差异（RR：1.02，95% CI：0.50-2.11 p=0.95）。激光组因尿液外渗而需要支架定位的风险较高，但差异未达到显着性（RR：0.49，95% CI：0.17-1.41 p=0.19）。结论 与钬激光 PCNL 相比，非激光 PCNL 显示出更好的围手术期结果和 SFR。