• Sung Ku Kang, Kang Su Cho, Dong Hyuk Kang, Hae Do Jung, Jong Kyou Kwon, and Joo Yong Lee.
• Department of Urology, Severance Hospital Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul Department of Urology, Inha University School of Medicine, Incheon Department of Urology, Yongin Severance Hospital, Yonsei University Health System, Yongin Department of Urology, Severance Check-Up, Yonsei University Health System, Seoul, Korea.
• Medicine (Baltimore). 2017 Dec 1; 96 (49): e9119.

BackgroundWe performed a systematic review and meta-analysis comparing stone-free rates between retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL), using updated, more reliable evidence.Materials And MethodsRandomized controlled trials comparing RIRS and PCNL for >2 cm stones were identified from electronic databases. Stone-free rates for the procedures were compared by qualitative and quantitative syntheses (meta-analyses). Outcome variables are shown as risk ratios (RRs) with 95% confidence intervals (CIs).ResultsEleven articles were included in this study. Most recently published studies exhibited relatively low quality during quality assessment. For the meta-analysis comparing success (stone-free) rates between PCNL and RIRS, the forest plot using the random-effects model showed an RR of 1.11 (95% CI 1.02-1.21, P < .014) favoring PCNL. After determining the among-study heterogeneity, subgroup analysis was performed of 9 studies with less heterogeneity: the stone-free rate of PCNL was superior to that of RIRS using a fixed-effect model (RR 1.07, 95% CI 1.01-1.14, P < .019) for these studies.ConclusionsRIRS can be a safe and effective procedure for selected patients with large renal stones. However, in this meta-analysis, the postoperative stone-free rate of PCNL was higher than that of RIRS in patients with >2 cm renal stones.

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