Tubeless versus standard percutaneous nephrolithotomy: an update meta-analysis

Abstract

BackgroundTo update a previously published systematic review and meta-analysis on the efficacy and safety of tubeless percutaneous nephrolithotomy (PCNL).MethodsA systematic literature search of EMBASE, PubMed, Web of Science, and the Cochrane Library was performed to confirm relevant studies. The scientific literature was screened in accordance with the predetermined inclusion and exclusion criteria. After quality assessment and data extraction from the eligible studies, a meta-analysis was conducted using Stata SE 12.0.ResultsFourteen randomized controlled trials (RCTs) involving 1148 patients were included. Combined results demonstrated that tubeless PCNL was significantly associated with shorter operative time (weighted mean difference [WMD], −3.79 min; 95% confidence interval [CI], −6.73 to −0.85; P = 0.012; I2 = 53.8%), shorter hospital stay (WMD, −1.27 days; 95% CI, −1.65 to −0.90; P < 0.001; I2 = 98.7%), faster time to return to normal activity (WMD, −4.24 days; 95% CI, −5.76 to −2.71; P < 0.001; I2 = 97.5%), lower postoperative pain scores (WMD, −16.55 mm; 95% CI, −21.60 to −11.50; P < 0.001; I2 = 95.7%), less postoperative analgesia requirements (standard mean difference, −1.09 mg; 95% CI, −1.35 to −0.84; P < 0.001; I2 = 46.8%), and lower urine leakage (Relative risk [RR], 0.30; 95% CI 0.15 to 0.59; P = 0.001; I2 = 41.2%). There were no significant differences in postoperative hemoglobin reduction (WMD, −0.02 g/dL; 95% CI, −0.04 to 0.01; P = 0.172; I2 = 41.5%), stone-free rate (RR, 1.01; 95% CI, 0.97 to 1.05; P = 0.776; I2 = 0.0%), postoperative fever rate (RR, 1.05; 95% CI, 0.57 to 1.93; P = 0.867; I2 = 0.0%), or blood transfusion rate (RR, 0.79; 95% CI, 0.36 to 1.70; P = 0.538; I2 = 0.0%). The results of subgroup analysis were consistent with the overall findings. The sensitivity analysis indicated that most results remained constant when total tubeless or partial tubeless or mini-PCNL studies were excluded respectively.ConclusionsTubeless PCNL is an available and safe option in carefully evaluated and selected patients. It is significantly associated with the advantages of shorter hospital stay, shorter time to return to normal activity, lower postoperative pain scores, less analgesia requirement, and reduced urine leakage.

Tubeless supra‐costal percutaneous nephrolithotomy is associated with significantly less hydrothorax: a prospective randomized clinical study

“…Since then, there have been several randomized prospective controlled studies demonstrating that tubeless PCNL confers an advantage in terms of postoperative discomfort, analgesic requirement and LOS, when compared to standard PCNL with an NT [20][21][22]. Several reviews and meta-analyses, summarizing dozens of studies, have revealed similar complication rates between standard and tubeless PCNL [10,11,23], however, no stratification by access (supra-or infra-costal) was performed in any of these publications.…”

“…The tubeless approach has been repeatedly shown to result in reduced pain, debilitation, LOS and cost when compared to the standard approach [10,11,23]. Furthermore, in a study investigating extra-renal findings in 100 patients after PCNL, non-contrast CT demonstrated that the amount of gutter and perinephric fluid in patients left with an NT was approximately two times larger than in patients left with only a JJ stent [24].…”

Comparison of standard and tubeless percutaneous nephrolithotomy for renal calculi: a prospective randomized control trial

“…18 With the advent of tubeless PCNL in the 1990s, the morbidity of the nephrostomy tube is completely avoided and it gained widespread popularity in recent years. 19 However certain drawbacks like stent-related symptoms and intraoperatively missed residual fragments which needed auxiliary treatment were seen in some tubeless PCNL studies. 20,21 Even though many RCTs were conducted in evaluating the efficacy and safety of tubeless PCNL, it remains as inconclusive evidence because of the quality and quantity of the analyzed RCTs.…”

Comparison of Percutaneous Nephrolithotomy Under Regional versus General Anesthesia: A Meta-Analysis of Randomized Controlled Trials

“…We speculated that the high heterogeneity may be due to each study calculated operative time using different criteria, and several studies did not state a clear definition of the operative time involved. Furthermore, the surgeon's experience and patient characteristics were likely the primary factors influencing operative time [21].…”