Table 1.
Characteristics of included studies
| Authors | Stone size | Staghorn stones: Partial/Full | Definition of stone-free status | Ancillary procedures for residual fragments | Stone-free rate (%) | Recurrence rate (%) | Intraoperative complications N°, (%) | Mean/median length of stay in neurological patients, days | Mean/median length of stay in non-neurological patients, days | Factors affecting complications | Complications in neurological patients | Complications in non-neurological patients |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Alsinnawiet et al., 2013 | Mean 940 mm3 (range 360–1,200) | Not reported | Degree of stone clearance was determined by X-ray | SWL or second-look PCNL | 60% | 80% | Bleeding and Hypotension 1, (25%) | Not reported | / | Not reported | Fever (100%) | / |
| Baldea et al., 2017 | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | LOS, mean (SD) 14.2 days (22.1) | LOS, mean (SD) 9.6 days (12.5) | Spinal cord injury | Pneumonia 96 (5.1%) Sepsis 143 (7.6%) Mortality 80 (4.2%) Myocardial infarction 21 (1.1%) |
Pneumonia 50 (2.7%) Sepsis 61 (3.2%) Mortality 59 (3.1%) Myocardial infarction 22 (1.2%) |
| Beraud et al., 2022 | Not reported | Not reported | Not reported | Not reported | Not reported | Neurological group 11.6% (12 months) 15.3% (18 months) 18.3% (24 months) |
Not reported | SM (3.0 ±5.6 days) SD (4.3 ±6.7 days) P (4.4 ±11.2 days) T (3.8 ±9.1 days) Overall (3.4 ±7.1) |
1.2 (± 2.9) | Not reported | UTI (<10 days following procedures) SM (15,34%), Spinal dysraphism (23.98%), Paraplegia (19.56%) Tetraplegia (20.70%) Neurological (17.70%) |
UTI (<10 days following procedures) (3.14%) |
| Chaudhry et al., 2017 | PCNL 2.6 cm (IQR 1.5–2.9) CLL 2.8 cm (IQR 2.2–4.3) |
Not reported | Not reported | PCNL | PCNL 60% CLL 71% |
Not reported | PCNL group Bleeding 1, (4.3%) | PCNL LOS 4.4 days (IQR 3.5–4.6) CLL LOS 1,4 days (IQR 1.2–1.9) |
/ | Cobb-S angle >60 degrees | SIRS in 4 patients after PCNL | / |
| Chen et al., 2002 | Not reported | Not reported | Not reported | Not reported | 83% | 34% (5 y) | Not reported | Not reported | / | Not reported | Not reported | / |
| Christman et al., 2013 | Median NGB 6 mm (4–8) Control group 7 mm (5–10) |
Not reported | No stones on renal/ bladder TC or US or URS | / | 63% NGB 86.6% Control |
45% NGB 14.5% Control |
/ | Not reported | Not reported | / | Bacteriuria 67% Pain with stone episode 24% |
Bacteriuria 16.4% Pain with stone episode 84.7% |
| Clifton et al., 2014 | Not reported | Not reported | No evidence of residual or recurrent nephrolithiasis on CT, urogram, nephrostogram and US | 13, PCN 7, URS 4, SWL |
47.4% | 19.0% | Not reported | Not reported | / | Hypercalciuria secondary to immobilization, chronic infection and indwelling catheters | / | / |
| Culkin et al., 1986 | Not reported | 7 (2/5) | Renal tomograms followed by nephrostogram | PCNL | 90.4% | 65.2% | RA (3.6%) Hydrothorax (3.6%), Perirenal abscess (7.2%) |
Not reported | Not reported | Atelectasis, Infected decubiti | Bacteriuria 100%, Indwelling Foley catheters 60.9%, Fever 64.3%, Dislodged nephrostomy 21.4%, Anemia 27.8% |
/ |
| Culkin et al., 1990 | Not reported | SCI 13 (8/5) Control Group 6 (4 /2) |
Renal tomograms followed by nephrostogram | PCNL | 88.6% SCI 98.5% Control 94% Overall |
Not reported | Perirenal abscesses, RA, pneumonia, nephrocolonic fistula, hydrothorax. 1 mortality for CID |
Not reported | Not reported | Respiratory problems, complex stone disease | Perirenal abscess (8.8%) Aspiration pneumonia (2.8%) Hydrothorax (2.8%; Nephrocolonic fistula 2.8%; Respiratory arrest 2.8% Hemorrhage (48.6%); fever (74.2%) Dislodged nephrostomy tube (17.1%) Retained stones (11.4%) |
Nephrodudenal fistula (1.4%) Hemorrhage (20%); Fever (12.3%) Dislodged nephrostomy tube (4.6%) Retained stones (1.5%) Ureteral edema (6.1%) |
| Eswara et al., 2013 | Median Same day PCNL 15 (range 7–40 mm) Delayed PCNL 18 (range 5–36 mm) |
Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | Same-day PCNL: LOS 4 days (range 2–50) Delayed PCNL: LOS 3 days (range 2–14) |
/ | Urinary stasis, Recurrent UTI, Indwelling catheters, RVU |
/ | / |
| Ganesan et al., 2017 | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | / | Not reported | Not reported | / |
| Gnessin et al., 2011 | Not reported | Not reported | Not reported | PCNL second look | Not reported | Not reported | Not reported | / | / | Infected urine, Vesicoureteral reflux, catheterization, neurogenic bladder | / | / |
| Irwin et al., 1991 | Mean stone burden SB 3.4 cm SCI 1.9 cm |
8 | Not reported | SWL | OPEN 71% PCNL 70% |
OPEN 0% PCNL 20% |
Not reported | OPEN: Mean LOS 22 days (8–60) PCNL: Mean LOS 7 days (5–14) |
/ | Stone burden Skeletal deformities |
Fever 16 (100%) Hemorrhage 1 (6.2%) pain 4 (25%) Wound infection 2 (12.5%) UTI 3 (18.85%) Pressure sores 2 (12.5%) |
/ |
| Knox et al., 2012 | Mean 3.31 cm | Not reported | No evidence of stone on imaging (RX, TC IVU) after procedure | 7, PCNL 4, SWL 1, URS |
Initial stone-free rate 60.6% Final stone free rate 69.7% |
Not reported | Not reported | Mean LOS 5.3 days 9 patients needed ICU-care and mean LOS was 13.9 days |
/ | Multiple access and increasing stone | Fever 12 (25.5%) Sepsis 8 (17%) Pyelonephritis 1 (2.1%) Acute respiratory distress syndrome 2 (4.2%) Bleeding/Transfusion 4 ((,4%) Arteriovenous fistula 1 (2.1%) Amputation extremity 1 (2.1%) Pressure wound (1 2.1%) Death 1 (2.1%) Acute renal failure 2 (4.2%) Hemothorax 1 (2.1%) |
/ |
| Lawrentschuk et al., 2005 | Mean stone area 480 (70–3500) mm2 | 24 | Stone fragments >2 mm | 2 monitored 2 SWL 2 URS 1 pyelolithotomy |
87% | Not reported | Not reported | Not reported | / | Not reported | Fever 58% Blood transfusion 12% Calyceal perforation 8% Pneumothorax 8% Urosepsis 4% |
/ |
| Lazare et al., 1988 | Mean stone burden was 2.9 cm (range 0.2 to 8.0 cm.) | 7 (2/5) | Free of stones or without any radiographic evidence of calcification overlying the collecting system | 2 nephrostomy 1 PCNL 1 cystolitholopaxy |
73% | Not reported | Not reported | Not reported | / | No Double J or nephrostomy insert before SWL | Sepsis 1 (3%) | / |
| Matlaga et al., 2006 | Not reported | Not reported | No evidence of calculi by CT imaging in first postoperative day | Not reported | 30% | Not reported | Not reported | Mean LOS 3.3 days (range 2 to 10) | / | Not reported | Fever 6, (18.75%) Pressure sore 1 (3.1%) |
/ |
| Mitchell et al., 2018 | Not reported | 43 | No evidence of calculi in postoperative imaging. (unenhanced CT, US, and/or intravenous urogram) | Not reported | 46% SB 82% non-SB |
23% SB 0% non-SB |
SB 6, (23.5%) 2 anesthetic, 3 bleeding, 1 renal pelvic perforation; 2 difficult access non-SB 2 (4.9%) bleeding |
Median (IQR) hospital stay 7 days (6 to 8) | Median (IQR) hospital stay 4 days (3 to 5) | Mobilization was a problem for pressure sores; increased prevalence of matrix stone is a problem for sepsis; Risk of bleeding was much higher in SB for difficult percutaneous access. | Sepsis 38% Transfusion 11.8% | Sepsis 1.6%, Transfusion 1.6% |
| Morhardt et al., 2018 | Mean stone burden 15.7 mm ±11.2 | Not reported | CT, ultrasound, and plain radiography | Second and third look URS | 17% | Not reported | 0% | Mean LOS days ±SD (range) 3.1 ±1.9 (Range 1-8) | / | Primarily urinary tract infections | Primarily urinary tract infections 19 (15%), Sepsis requiring intensive care unit 2 (2%) |
/ |
| Nabbout et al., 2012 | Average 31.3 mm (exclude staghorn) |
8 (30.8%) | Complete absence of stones or presence of insignificant fragments (<2 mm) at CT scan one day after procedure | Second and third look PCNL | PCNL 53.8% 2nd PCNL 80.8% 3rd PCNL 88.5% |
Not reported | Bleeding 6 (28.6%) | Not reported | / | Limited pulmonary capacity and prolonged immobilization, making the anesthetic requirements more complicated | Urosepsis 3 (4.3%) Transfusion 6 (28.6%) Pneumothorax 1 (4.7%) Perforation 1 (4.7%) |
/ |
| Niedrach et al., 1991 | Average of the length of each stone 33.4 mm | 0 | No visible stone at plain-abdominal x-ray | Not reported | 44% | Not reported | Not reported | Average LOS 3.3 days (1–8) | / | Not reported | hypertension1, (9%) hypotension1 (9%) bradycardia 1 (9%) |
/ |
| Prattley et al., 2019 | Mean stone length, mm 26.7 ±14.5 [5–59] | 0 | Residual fragments were less than 2 mm at XRKUB, US or CTKUB | Second look URS | 47% | 42% | Not reported | Median LOS 1 days (range, 0–9) | / | Not reported | urinary infections 2 (10%) sepsis 3, (14%) lower respiratory tract infection 2, (10%) |
/ |
| Raj et al., 1999 | Mean aggregate stone diameter ±SD 22.3 mm ±18.0 (2–77) |
Not reported | Absence of stones on postoperative imaging (X-ray or CT) | Not reported | 55% | 73% | Not reported | Not reported | / | Not reported | Not reported | / |
| Robert et al., 1995 | Mean of maximum dimension 11 mm (range 5–35) | Not reported | Fragment <3 mm at plain abdomen radiograph | URS | 53% | 14% | Not reported | Not reported | / | Not reported | Few cases of gross hematuria which spontaneously regressed | / |
| Rubenstein et al., 2004 | Not reported | Not reported | Removal of the entire stone burden to visual completion with no fragments seen on follow-up imaging | Second PCNL | 96% | Not reported | Hydrothorax 1, (4.3%); Respiratory difficulty 1, (4.3%); Collecting system perforation 1, (4.3%) |
Average LOS 7.04 days (range 1 to 22) | / | Atelectasis poor thermoregulatory mechanisms, pyelolymphatic backflow of bacteria |
Fever 11, (47.8%) Hydrothorax 1, (4.3%) Hydrothorax 1, (4.3%) Retroperitoneal abscess 1, (4.3%) Ileus 1, (4.3%) |
/ |
| Sofimajidpour et al., 2016 | Mean of kidney stone size 35.7 ±6.1 mm (25 to 45 mm) | 8 0/8 |
KUB and kidney US first day after surgery, Non-contrast CT 6 months after surgery | Second PCNL | First PCNL, 53.1 % Second PCNL 78.1% |
Not reported | Not reported | Mean LOS 8.3 ±3.1 days | / | Not reported | Blood transfusion, 7 (24.1%) Visceral injury, 2 (6.8%) ICU stay, 7 (24.1%) Urosepsis, 6 (20.6%) Fever 11 (38%) |
/ |
| Spirnak et al., 1988 | Not reported | 1 0/1 |
Not reported | Not reported | 60% | Not reported | Hypertension | LOS ranged from 5 to 43 days (mean 17 days) | / | Not reported | Not reported | / |
| Stauffer et al., 2017 | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | Febrile UTI 9% | Febrile UTI 1.4% |
| Symons et al., 2006 | Stone size ranged from 10 to 60 mm; without staghorn the mean stone size was et al, 26 mm |
13 0/3 |
Not reported | PCNL SWL URS |
48.7% | Not reported | Not reported | Not reported | / | Difficult airways, abnormal anatomy increasing the risk of pneumothorax and a reduction in respiratory capacity | Death 2 (6.9%) major complications 5, (17.2%) minor complications 8 (27.5%) |
/ |
| Tepeler et al., 2015 | Mean stone size was 15.9 ±8.6 (6–40) mm | Not reported | Residual stone fragments <3 | 1 | 66.6 % | 5 | None | Mean LOS 2.0 ±2.4 (0–10) days | / | Not reported | Fever 6 (22.2 %) Hypotension 1 (3.7%) UTI 1 (3.7%) Urosepsis 1 (3.7%) Respiratory failure 2 (7.4%) |
/ |
| Torricelli et al., 2021 | Not reported | Not reported | Absence of any fragments on postoperative day 1 at CT scan. | Second look PCNL, FURS or SWL | 48.70% | Not reported | None | Mean LOS 5.8 ±4.7 days | Mean LOS 3.1 ±1.7 days | Infection, Hypotension Bleeding |
Clavien 1 = 1 (2.6%) Clavien 2 = 8 (20.5%) Clavien 3 = 0 (0%) Blood transfusion: 5.1% |
Clavien 1 = 0 (0%) Clavien 2 = 3 (3.9%) Clavien 3 = 3 (3.9%) Blood transfusion: 1.3% |
| Wahle et al., 1988 | Not reported | 22 | Not reported | 5 SWL 4 nephrostomy tube placement (1 steinstrasse requiring URS) |
25% 42% (had between 90 and 99% reduction in stone surface area). |
Not reported | None | Average of 4.2 days, (IQR 2–14) | / | Not reported | 1 nephrectomy five months after SWL. 1 patient with a proximal right ureteral stone underwent ureterolithotomy |
/ |
| Welk et al., 2013 | Not reported | Not reported | Not reported | Multiple PCNL | Not reported | Not reported | None | Median of LOS 5 days (IQR 3–8). | / | Not reported | The 30-day mortality rates after any stone-related procedure was low. Subsequent ICU admission was required in 12% of cases; none occurred after SWL. ACUTE KIDNEY INJURY with the need for dialysis was rare |
/ |
| Wolfe et al., 2013 | Stone size <1 cm: 32.8%; 1.0–2.0 cm: 35.8%; >2 cm: 31.3% |
Not reported | Removal of any stone larger than 4 mm | URS 31% SWL 16% PCNL 15% |
34.40% | 71.60% | Ureteral perforation (1.5%) | Not reported | / | Chronic obstructed pulmonary disease | Urosepsis (17.9% Respiratory failure (4.5%) Acute outlet obstruction (4.5%) |
/ |
| Wong et al., 2023 | Not reported | Not reported | Not reported | URS; SWL; PCNL | Not reported | Not reported | Not reported | Not reported | / | Not reported | Not reported | / |
CT – computed tomography; URS – ureteroscopy; SWL – extracorporeal shock wave lithotripsy; PCNL – percutaneous nephrolithotomy; LOS – length of stay; CLL – cystolitholapaxy; SIRS – systemic inflammatory response syndrome; MS – Multiple sclerosis; UTI – urinary tract infection; IQR – interquartile range; NGB – neurogenic bladder; ICU – intensive care unit; SD – standard deviation; FURS – ; KUB – kidney ureter bladder; US – ultrasound; IQR – interquartile range