Complications and outcomes of tubeless versus nephrostomy tube in percutaneous nephrolithotomy: a systematic review and meta-analysis of randomized clinical trials

Abstract

We aimed to perform a systematic review of randomized trials to summarize the evidence on the safety and stone-free rate after Tubeless percutaneous nephrolithotomy (PCNL) (ureteral stent/catheter, no nephrostomy) compared to Standard PCNL (nephrostomy, with/without ureteral stent/catheter) to evaluate if the tubeless approach is better. The inverse variance of the mean difference with a random effect, 95% Confidence Interval (CI), and p values was used for continuous variables. Categorical variables were assessed using Cochran–Mantel–Haenszel method with the random effect model, and reported as Risk Ratio (RR), 95% CI, and p values. Statistical significance was set at p < 0.05 and a 95% CI. 26 studies were included. Mean operative time was significantly shorter in the Tubeless group (MD—5.18 min, 95% CI − 6.56, − 3.80, p < 0.00001). Mean postoperative length of stay was also significantly shorter in the Tubeless group (MD—1.10 day, 95% CI − 1.48, − 0.71, p < 0.00001). Incidence of blood transfusion, angioembolization for bleeding control, pain score at the first postoperative day, the number of patients requiring postoperative pain medication, fever, urinary infections, sepsis, perirenal fluid collection, pleural breach, hospital readmission, and SFR did not differ between the two groups. Incidence of postoperative urinary fistula was significantly lower in the Tubeless group (RR 0.18, 95% CI 0.07, 0.47, p = 0.0005). This systematic review shows that tubeless PCNL can be safely performed and the standout benefits are shorter operative time and hospital stay, and a lower rate of postoperative urinary fistula.

A randomized controlled study of ureteral stent extraction string on patient’s quality of life and stent-related complications after percutaneous nephrolithotomy in the prone position

“…Moreover, the double-J stent is equally essential considering its function: (I) prevention of postoperative ureteral oedema and stricture; (II) promotion of the residual stones removal and adequate internal drainage [ 18 – 20 ]. Recently, tubeless PCNL has been investigated, mainly including standard tubeless (postoperative placement of ureteral stent only) and totally tubeless (neither ureteral stent nor nephrostomy tube) [ 5 , 21 ]. Numerous studies have demonstrated that the tubeless PCNL (ureteral stent only) technique is being employed with increasing frequency.…”

“…During PCNL, it is typically recommended to place a nephrostomy tube and double-J stent to ensure proper urine drainage, facilitate the discharge of residual stones, and assist with compression hemostasis [ 4 ]. Recently, with the improvement of PCNL technology and the emphasis of enhanced recovery after surgery, more and more studies have demonstrated that tubeless PCNL (with ureteral stent but without nephrostomy tube) is a safe and ideal surgical approach [ 5 – 7 ]. Nevertheless, the internal double-J stent needs to be removed with a cystoscope in the outpatient clinic, which increases the patient's cost and pain and raises the risk of bleeding, infection, and urethral injury [ 8 ].…”

Clinical Prediction Model for Severe Pain After Percutaneous Nephrolithotomy and Analysis of Associated Factors ：A Retrospective Study

“…A meta-analysis [23] indicated that standard and mini PCNL was not signi cantly different in terms of postoperative pain, fever, complications, and duration of operation. Gauhar et al [24] concluded that tubeless PCNL (absence of ureteral stent and nephrostomy tube) had a shorter mean operative time than standard PCNL treatment, but there was no signi cant difference in postoperative pain scores and analgesic requirements. Complex kidney stones are kidney stones with complex and diverse parameters such as stone components, size, shape, number, and location, including ectopic kidney stones, multiple kidney stones, and isolated kidney stones.…”

Comparing Tubeless and Tubed Approaches in Percutaneous Nephrolithotomy for Moderate Renal Calculi: Outcomes on Safety, Efficacy, Pain Management, Recovery Time, and Cost-Effectiveness

“…The idea of the "tubeless" PCNL was born, whereby a nephrostomy tube is not left in place following the percutaneous procedure, but rather, renal drainage is established with an indwelling ureteral stent [ 3 , 4 ]. A large number of studies on tubeless PCNL have been performed, and several previously published systematic reviews have reported its efficacy and safety [ 5 - 14 ]. Several randomized controlled trials (RCTs) have been performed to compare the safety and efficacy of tubeless and standard PCNL, including multiple high-quality RCTs [ 6 , 13 , 15 , 16 ].…”