Comparison of Contrast-Enhanced Ultrasound Conventional Ultrasound-Guided Percutaneous Nephrolithotomy in Nondilated Collecting System: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

It has been demonstrated that ultrasound (US)-guided renal collecting system access during percutaneous nephrolithotomy (PCNL) is efficient and secure. The puncture success rate fell to 82%, and the total complication rate rose to 15% in kidneys with nondilated collecting systems. Contrast-enhanced ultrasonography (CEUS) has been used in PCNL techniques to address this issue. We did this meta-analysis following the preferred reporting criteria for systematic reviews and meta-analysis to combine the data of published studies to compare the CEUS-guided PCNL and the standard US-guided PCNL (PRISMA). For relevant literature, we searched PubMed, Embase, Web of Science, CKNI, and the Cochrane Library. The final inclusion date for this meta-analysis was May 1, 2022, and three randomized controlled trials (RCTs) were finally included. RevMan V5.4.1 was used in this work. Standard mean difference (SMD) with a 95% confidence interval (CI) was utilized as the major estimate in the synthesis of continuous data, while odds ratio (OR) with a 95% CI was synthesized as the main estimate in the synthesis of discontinuous data. We found that compared with traditional US-guided PCNL, CEUS-guided PCNL could offer more benefits in terms of single-needle success rate (OR: 3.02, 95% CI: 1.62 to 5.61,  = 0.0005), shorter puncture time (SMD: -1.33, 95% CI: -2.06 to -0.60,  = 0.0004), shorter hospital stays (SMD: -0.37, 95% CI: -0.60 to -0.13,  = 0.002), and a better stone clearance rate (OR: 2.32, 95% CI: 1.15 to 4.68.  = 0.02). Although the PCNL complication rate after surgery was not significantly reduced by the CEUS technique (overall complication: OR = 0.70, 95% CI: 0.37 to 1.30,  = 0.25. Grade 1/2 complication: OR = 0.79, 95% CI: 0.41 to 1.53,  = 0.48; Grade 3/4 complication: OR = 0.44, 95% CI: 0.10 to 1.98,  = 0.28), it could reduce hemoglobin dropping compared with conventional US-guided PCNL (SMD: -0.82, 95% CI: -1.06 to -0.58,  < 0.001). The CEUS-guided PCNL technique is superior to the US-guided PCNL, according to almost all synthesized data. Additional randomized studies are still required.