The efficacy and safety of tubeless percutaneous nephrolithotomy: a systematic review and meta-analysis

Abstract

The objective of this study was to conduct a systematic review and meta-analysis to evaluate the efficacy and safety of tubeless versus standard percutaneous nephrolithotomy (PCNL). Relevant randomized or quasi-randomized controlled trials studies were identified from electronic database (Cochrane CENTRAL, Medline and EMBASE et al.). The retrieval time ended in August 2010. The quality of the included trials was assessed and the data were extracted independently by two reviewers. We divided the participants who received standard PCNL into two subgroups: small tube (4-10 F) group and big tube (14-24 F) group to reduce heterogeneity and bias. Efficacy (hospital stay time, operative time, stone-free rate) and safety (postoperative pain and analgesia requirement, postoperative fever, blood transfusion, urine leakage) were explored by using review manager v5.0. Fourteen randomized controlled trials comprising 776 subjects met the inclusion criteria. Our meta-analysis showed that there were statistically significant differences in hospital stay, postoperative analgesic requirement and urine leakage between tubeless and standard PCNL. In operative time, significant difference was found between tubeless and big tube group. No statistically significant differences were found in stone-free rate, postoperative fever, and blood transfusion between tubeless and standard PCNL. In conclusion, Tubeless PCNL was an effective and safe procedure for treatment of renal stones in selected patients, with shorter hospital stay, less analgesic requirement, lower urine leakage and without increased complications. Patients can receive great benefit from tubeless PCNL and it will become more palatable to patients as well as more cost-effective than standard PCNL in the future.

Percutaneous Nephrolithotomy for Staghorn Stones in Patients with Solitary Kidney in Prone Position or in completely Supine Position: a Single-center Experience

“…Staghorn calculi are branched stones that occupy a large portion of the collecting system, typically fl ling the renal pelvis and branching into several or all of the calices (1). Treatment of staghorn stones in patients with solitary kidney is one of the most challenging problems in urology (2).…”

Outcomes of Standard or Tubeless Percutaneous Nephrolithotomy

“…3 Literatürde tüpsüz PNL uygulamasının analjezi gereksinimini azalttığı, hastanede kalış süresini ve normal hayata dönme süresini kısalttığı bildirilmiştir. [4][5][6][7] Seçilmiş olgularda tüpsüz PNL'nin konvansiyonel yöntem ile aynı etkinlik ve güvenirlilikte olduğu rapor edilmiştir. [4][5][6][7] Bu çalışmada, PNL ameliyatları sonrası drenaj tercihlerinin incelenmesi, ayrıca tüplü ve tüpsüz PNL prosedürlerinin, operatif ve postoperatif etkilerinin değerlendirilmesi amaçlanmıştır.…”

Outpatient tubeless percutaneous nephrolithotomy and concomitant cystolitholapaxy

“…These approaches have improved the surgical outcomes of PCNL, reducing both postoperative pain and length of stay. 2,[4][5][6] Despite this, and despite the potential financial benefits to the healthcare system, few centres have explored the use of tubeless PCNL as an outpatient procedure. [7][8][9] To the best of our knowledge, there is only 1 published report on standard PCNL done on an outpatient basis, and this report involved 5 patients.…”