Kind of Caox Crystal | Figure 1

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What are the benefits and risks of tranexamic acid for percutaneous nephrolithotomy for the treatment of kidney stones?

Key messages
• Tranexamic acid, when compared to placebo (or no medication), may reduce blood transfusions, surgical complications, and a patient's hospital stay following percutaneous nephrolithotomy.
• Tranexamic acid, when compared to placebo (or no medication), may improve the removal of stone material following percutaneous nephrolithotomy but may increase unwanted medication effects.
• We do not know if tranexamic acid affects the risk of blood clots forming in other parts of the body following percutaneous nephrolithotomy.

What did we want to find out?
We wanted to find out if giving tranexamic acid was better (or worse) than not giving tranexamic acid. The main outcomes we were interested in were blood transfusions, completeness of stone removal, and the risk of blood clots forming in other parts of the body. We also studied unwanted medication effects, the need for more stone procedures, major and minor surgical complications, unplanned returns to the hospital, and length of stay in the hospital.

What did we find?
We found 10 studies that used tranexamic acid as an infusion by vein and one study that added tranexamic acid to the irrigation fluid. Based on these studies, tranexamic acid may reduce blood transfusions and improve stone removal. However, we do not know if tranexamic acid affects blood clots forming in other parts of the body when infused by a vein, or added to the irrigation fluid used for percutaneous nephrolithotomy.

What are the limitations of the evidence?
We have little confidence in most of the evidence, and for some of the results, we are confident in the evidence. Reasons for low confidence include concerns about whether participants in both groups were managed and evaluated the same way. Also, in some instances, the results of the included studies were quite different, the studies were small, or there were not enough studies to be sure of the effect.

Comparison of two treatment options for kidney stones

How are kidney stones treated?
People with large kidney stones often need treatment. Two common ways to treat them are called percutaneous lithotripsy (PCNL) and retrograde intrarenal surgery (RIRS). PCNL involves placing a small tube from the skin into the kidney and then using different instruments to break up and remove the stones. RIRS involves placing a long viewing tube through the urethra (the tube connecting the bladder to the outside of the body) and the ureter (the tube connecting the bladder and the kidney) into the kidney, then using different instruments to break up and remove the stones. It is unclear how the two treatments compare.

What did we want to find out?
We wanted to know if PCNL was better than RIRS for treating kidney stones.

What did we do?
We searched for studies that compared PCNL with RIRS in adults with kidney stones of any size and located in any part of the kidney.

What did we find?
We found 42 studies that randomly allocated participants to either PCNL or RIRS. There were 4571 participants in total. The average age of participants was between 27.7 years and 59.3 years, and the average stone size was between 10.1 mm and 39.1 mm.

Main results
We found that compared with people treated with RIRS, people treated with PCNL may be more likely to be free of stones after the procedure and less likely to need another procedure to remove remaining stones. PCNL probably does not increase the risk of serious complications, although it may result in a longer hospital stay. We also found that people treated with PCNL may be no more likely to have a stricture of the ureter than people treated with RIRS. We did not find any evidence for unplanned medical visits or quality of life.

What are the limitations of the evidence?
We have little confidence in the evidence for most results, mainly because the studies were not well planned or carried out and because the results varied considerably across studies.