To systematically review the efficacy and safety of minimally invasive percutaneous nephrolithotomy (mPCNL) combined with flexible ureteroscopic lithotripsy (FURL) for complex renal calculi.

A systematic literature search in PubMed, Cochrane Library, Embase, CNKI, VIP, CBM and WanFang Data was performed to identify all randomized controlled trials (RCTs) that published before May 1st, 2020 and compared the efficacy and safety of mPCNL combined with FURL (combined group) or not (non-combined group) for complex renal calculi. Meta-analysis was subsequently performed by RevMan 5.2 and Stata 12.0.

Thirteen RCTs with a total of 1198 patients were included. Compared with non-combined group, combined group provided a higher primary stone-free rate [RR=1.23, 95%CI(1.17, 1.30), P<0.001], less intraoperative blood loss [MD=-29.81, 95%CI(-46.94, -12.69), P=0.0006], shorter hospital days [MD=-1.09, 95%CI(-1.67, -0.51), P=0.0002], and lower rate of postoperative bleeding [RR=0.24, 95%CI(0.10, 0.55), P=0.0007] and overall postoperative complications [RR=0.30, 95%CI(0.18, 0.49), P<0.001]. However, no significant differences were found in terms of operation time, postoperative infection and postoperative fever.

For complex renal calculi, combined group could improve stone-free rate, reduce intraoperative blood loss, hospital stay, postoperative bleeding, and overall postoperative complication rate, while did not increase the operation time and the occurrence of postoperative infection and postoperative fever.