Systematic Review and Meta-analysis Comparing Percutaneous Nephrolithotomy, Retrograde Intrarenal Surgery and Shock Wave Lithotripsy for Lower Pole Renal Stones <2cm in Maximum Diameter.

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The optimal treatment of lower pole stones (LPS) between 1-2cm represents a point of debate among the urologists.The aim of the current systematic review and meta-analysis is to provide an answer on which is the most appropriate approach for the management of the LPS with a maximal dimension ≤2cm.A systematic review was conducted on PubMed, SCOPUS, Cochrane and EMBASE. The PRISMA guidelines and the recommendations of the EAU Guidelines office were followed. Retrograde intrarenal surgery (RIRS), shock wave lithotripsy (SWL) and percutaneous nephrolithotomy (PCNL) were considered for comparison. Primary endpoint was the stone-free rate (SFR).15 randomized controlled trials (RCTs) were eligible. PCNL and RIRS have higher SFRs in comparison to SWL and require less retreatment sessions. Operative time and complications seem to favor SWL in comparison to PCNL, but this takes place in the expense of multiple SWL sessions. RIRS seems to be the most efficient approach for the management of stones up to 1cm in the lower pole.The pooled analysis of the eligible studies showed that the management of LPS should probably reside to PCNL or RIRS to achieve stone-free status over a short period and minimal number of sessions. For stones smaller than 10mm, RIRS is more efficient in comparison to SWL. The decision between the two approaches (PCNL or RIRS) should be individual, based on the anatomical parameters, the comorbidity and the preferences of each patient.

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