Retrograde Intrarenal Surgery Versus Percutaneous Nephrolithotomy Versus Extracorporeal Shock Wave Lithotripsy for Treatment of Lower Pole Renal Stones: A Meta-analysis and Systematic Review.

Background: The optimal treatment of lower pole renal stones continues to be a dilemma for urologists. Retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and extracorporeal shock wave lithotripsy (ESWL) all constitute viable therapeutic options in selected patients. The aim of this study was to assess the efficacy and safety of RIRS, PCNL and ESWL in management of lower pole renal stones. Methods: A literature search was performed in July 2014 using PubMed, Embase, and Web of Science databases. Literature reviewed included meta-analysis and randomized and nonrandomized controlled studies to identify relevant studies for the meta-analysis. Results: Six randomized and eight nonrandomized studies were identified for analysis. PCNL provided a significantly higher stone-free rate (SFR) compared with RIRS and ESWL. Furthermore, no statistical significant difference was found when PCNL was compared with RIRS and ESWL for complication rate. Compared to the other two treatments, RIRS had longer operative time and PCNL had longer hospital stay. ESWL was associated with significantly higher retreatment rate compared to RIRS and PCNL, whereas there were no significant differences in auxiliary procedure rates among the three treatment techniques. Conclusion: RIRS offers a relative higher SFR while has a longer operative time. PCNL is associated with the highest SFR at the expense of the longest hospital stay. ESWL is performed as an outpatient procedure with a relative shorter operative time, however, it has lower SFR and higher retreatment rate. The categories of complications vary while the overall complication rates are comparable among the three treatment techniques.