Comparison of Efficacy and Safety of Five Categories of Intracorporeal Lithotripsy Devices in Percutaneous Nephrolithotomy: A Systematic Review and Network Meta-Analysis of Randomised Control Trials

This study aims to assess the efficacy and safety of five categories of intracorporeal lithotripsy devices in percutaneous nephrolithotomy (PCNL): Pneumatic lithotripters, ultrasonic lithotripters, double-probe dual-energy lithotripters, single-probe dual-energy (SPDE) lithotripters and lasers. A network meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed, Embase and Cochrane were utilised to search for randomised controlled trials (RCTs) up to 10 August 2024. Surface under cumulative ranking area technique was used to rank interventions. Outcomes of interest included baseline characteristics, stone-free rate (SFR), complications, operative time and fragmentation time. Fourteen RCTs comprising 1516 procedures were included. No statistically significant difference was found in complications after using the devices. SPDE lithotripters (ratio of ratios (RR) = 1.90, 95% confidence interval (CI) = (1.11 to 3.28)) and lasers (RR = 1.76, 95% CI = 1.09 to 2.84) were associated with significantly higher SFR than pneumatic lithotripters. SPDE lithotripters significantly outperformed in decreasing operation time and fragmentation time. Based on the surface under the cumulative ranking curve (SUCRA) value, lasers and SPDE lithotripters performed better in SFR. In addition, SPDE lithotripters exhibited superior performance in terms of few complications and shortest fragmentation time and operative time. All five categories of devices were found to be equally safe for PCNL. SPDE lithotripters and lasers had higher efficacy. Moreover, SPDE lithotripters exhibited the shortest fragmentation time and operative time. These findings suggest that SPDE lithotripters have potential to be next-generation efficient lithotripsy devices.