Standard percutaneous nephrolithotomy for minimally invasive management of renal lithiasis in adults: an overview of systematic reviews

INTRODUCTION: Current protocols suggest using standard percutaneous nephrolithotripsy or other minimally invasive surgical techniques for kidney stone treatment. This generates controversy regarding which procedure is most effective and safe. The objective of this overview of reviews is to synthesize evidence from systematic reviews comparing the effectiveness and safety of standard percutaneous nephrolithotomy with other minimally invasive techniques for kidney stones in adults.EVIDENCE ACQUISITION: A protocol was registered on PROSPERO (CRD42023458878). We systematically searched Cochrane Library, PubMed, LILACS, and Epistemonikos for systematic reviews including randomized controlled trials comparing standard percutaneous nephrolithotomy with other minimally invasive techniques from database inception to September 2023. Primary outcomes included stone-free rate, retreatment rate, and major complications (Clavien-Dindo grade 3-5). The certainty of evidence was assessed using GRADE and the Risk of Bias with ROBIS. Results were summarized narratively, in tables, or figures.EVIDENCE SYNTHESIS: Five systematic reviews were included. All reviews compared standard percutaneous nephrolithotomy to minimally invasive percutaneous nephrolithotomy. Three were of critically low quality and two were of low quality. Three had a high risk of bias and two had an unclear risk of bias. Three reviews showed no substantial difference in stone-free rate, while two suggested minimally invasive percutaneous nephrolithotomy might have a slightly higher stone-free rate than standard percutaneous nephrolithotomy (moderate to very low certainty). No significant differences in major complications were observed between standard percutaneous nephrolithotomy and minimally invasive percutaneous nephrolithotomy (moderate to very low certainty).CONCLUSIONS: The evidence comparing standard and minimally invasive percutaneous nephrolithotomy regarding stone-free rate and major complications is inconclusive and of varying certainty. The available evidence exhibited limitations, including high risk of bias in many studies. High-quality randomized controlled trials are needed to enhance evidence certainty.