Tubeless vs standard percutaneous nephrolithotomy: a meta-analysis

To systematically review and compare tubeless percutaneous nephrolithotomy (PCNL) with standard PCNL.

We conducted a review of the English language literature on studies involving randomized controlled trials for PCNL. The studies chosen to be included in our review compared tubeless PCNL with standard PCNL and described the advantages of each in the outcomes. Two reviewers independently screened the studies for eligibility, evaluated their quality and extracted the data from the eligible studies, with confirmation by cross-checking. Data were processed using RevMan 5.0.

Seven studies involving 1365 cases met the inclusion criteria, and these were included in the meta-analysis. The patients' baseline characteristics were comparable in all the studies. By comparing the four common characteristics, we found no difference in efficacy between the two surgical approaches in terms of mean operation duration and postoperative haematocrit change (P > 0.05). We found that the mean analgesic requirement and number of days in hospital were lower for tubeless PCNL (P < 0.05).

Our results show that tubeless PCNL is a good option in non-complicated cases, with the advantages of reduced hospital stay and little need for postoperative analgesia. There was no difference between the two approaches in operation duration, or haematocrit change after surgery. As only few studies with small study populations were available, more high quality larger trials with longer follow-up are recommended.