| Popis: |
To perform a Bayesian network meta-analysis evaluating the safety and efficacy of endoscopic combined intrarenal surgery (ECIRS) in the Galdakao-modified supine Valdivia (GMSV) position versus prone split-leg (PSL) position. A systematic literature search of PubMed, EMBASE and Web of Science databases was executed to identify relevant studies. The clinical trials comparing ECIRS in GMSV position, ECIRS in PSL position and percutaneous nephrolithotomy (PCNL) in prone position for the management of renal calculi were included. The concerned outcomes were stone free rate (SFR), operation duration and complications. All endpoint variables were recorded as risk ratios (ORs) or weighted mean difference (WMD) with 95% confidence interval (CI). The present study was registered in International prospective register of systematic reviews (PROSPERO), number CRD42021292678. Two randomized controlled trials (RCTs) and 4 cohort studies or retrospective case-control studies (non-RCTs) were included in the Bayesian network meta-analysis. Of the 6 studies, 4 studies compared GMSV-ECIRS versus prone PCNL, 1 study compared GMSV-ECIRS versus PSL-ECIRS, and 1 study compared PSL-ECIRS versus prone PCNL. Bayesian network meta-analysis showed that GMSV-ECIRS had the similar SFR (OR 0.84, 95% CI 0.33 to 2.27), complication rate (OR 0.79, 95% CI 0.24 to 3.03) and operation time (WMD 23.62, 95% CI -70.15 to 112.51) when compared to PSL-ECIRS. However, in the rank-probability test, PSL-ECIRS had the highest SFR and the shortest operation duration, but GMSV-ECIRS had the lowest complication rate. Both GMSV-ECIRS and PSL-ECIRS were well established modalities for the management of kidney stones. PSL-ECIRS might have higher SFR, shorter operation time, while a little bit more complication than GMSV-ECIRS. Multiple-center RCTs with large sample size were required to certify the finding. |
