Intraoperative positioning strategies to improve stone-free outcomes during retrograde intrarenal surgery: a systematic review and meta-analysis.
Lin Wang, Wen Huang, Bin Wan et al.
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In 30 seconds
This systematic review and meta-analysis evaluated the impact of intraoperative positioning strategies on stone-free outcomes during retrograde intrarenal surgery (RIRS) for renal calculi, involving 998 patients across eight studies. The findings indicate that these strategies significantly improved stone-free rates compared to standard lithotomy, with a risk ratio of 1.20 (95% CI 1.12-1.28; P < 0.001).
Key findings
- Positioning strategies increased stone-free rates compared to standard lithotomy (RR 1.20, 95% CI 1.12-1.28; P < 0.001).
- Benefits were consistent for mixed intrarenal calculi and lower pole stones.
- Postoperative fever rates did not differ significantly between groups (RR 1.15, 95% CI 0.53-2.53; P = 0.720).
Why it matters
Improving stone-free rates during RIRS can enhance patient outcomes and reduce the need for additional interventions. Understanding the effectiveness of positioning strategies may inform surgical practices and improve overall procedural success.
What to keep in mind
Endpoint variability, limited reintervention data, and the absence of direct intrarenal pressure monitoring were noted limitations.