Efficacy of Minimally Invasive Percutaneous Nephrolithotomy with Holmium Laser and Pneumatic Ballistic for Renal Calculi: A Meta-analysis

Keywords:holmium laser, fiber,  Time:10-08-2015

Objective:
To compare the therapeutic efficacy and safety of holmium laser lithotripsy and pneumatic lithotripsy for renal calculi with minimally invasive percutaneous nephrolithotomy. To access the efficacy and safety of holmium laser treatment of renal calculi and provide the evidence for the clinical treatment. For patients in the operation of equipment selection provides evidence-based evidence.

Methods
Electronic searches of Pubmed, Cochrane library, SpringerLink, Embase,CNKI, VIP database, Wan Fang database to collect randomized study of holmium laser lithotripsy and pneumatic lithotripsy for renal calculi. Lives are set to retrieve from building a database to October 2013. All the literature data extracted independently by two investigators, and recommended the use of the Cochrane Collaboration risk of bias assessment tool to evaluate the test. Meta analysis was performed with RevMan5.0 software. Outcome measures included: gravel operation time, I drained the rate of healing stones, II stone clearance rate of treatment,clinical complications, blood loss,postoperative hospital stay,stone free time.

Result:
Documents in accordance with strict inclusion criteria, and ultimately into the randomized controlled clinical studies a total of six documents, included a total of 810 cases of patients with holmium laser lithotripsy group of 407 cases, pneumatic

lithotripsy group of 403 cases. Meta-analysis of the results showed:
(1)    Comparison of crushed stone operation time: After statistical analysis software by RevMan5.0 have TotalWMD=-13.79, 95%CI(-18.06,-9.51), Z=6.32,P=<0.000015 differences between the two groups in terms of operation time was statistically significant, holmium laser lithotripsy group operation time is shorter than the pneumatic lithotripsy group.
(2)    Compare stone clearance rate of Phase I treatment: Through the statisticalanalysis of RevMan5.0 software TotalWMD=-13.79, 95%CI(-18.06,-9.51),Z=6.32,P=<0.00001,I treat stone clearance rate of the two groups was statistically significant, compared with holmium laser lithotripsy phase I treatment lithotripsy stone clearance rate.
(3)    Compare stone clearance rate of Phase II treatment: Through thestatistical analysis of RevMan5.0 software RR=1.11? 95% CI(0.98,1.26),Z=1.70,P=0.09,two groups of treatment II stone clearance rate was statistically significant,compared with holmium laser lithotripsy phase II lithotripsy treatment of calculi drain rate.
(4)    Comparison of the incidence of clinical complications: After RevMan5.0statistical analysis software was RR--0.41, 95%CI (0.22,0.73),Z=3.00,P=0.003,two groups in the incidence of clinical complications was statistically significant,holmium laser lithotripsy the incidence of clinical complications set lower than pneumatic lithotripsy group.
(5)    Compare the amount of blood loss: After RevMan5.0 statistical analysis software combined data obtained TotalWMD = -24.41,95% CI (-26.2, -22.55), Z =25.72,P <0.00001,two aspects of blood loss the difference was statistically

Coclcusions:
Through the Meta analysis showed that two kinds of lithotripsy in the treatment of renal calculi with percutaneous nephrolithotomy compared to have the

following characteristics:
1、Holmium    laser lithotripsy time is shorter than pneumatic lithotripsy.
2、Holmium    laser lithotripsy have high stone clearance rate in treatment I and II.
3、Holmium    laser lithotripsy of stone clearance time is shorter than pneumatic lithotripsy group.
4、Holmium    laser lithotripsy compared pneumatic lithotripsy with less blood loss.
5、The    incidence of clinical complications of holmium laser lithotripsy lower than pneumatic lithotripsy group.
6、Holmium    laser lithotripsy group shorter than pneumatic lithotripsy group in the postoperative hospital stay.