Comparison between papillary and non-papillary access for percutaneous nephrolithotomy: a systematic review and...

Percutaneous nephrolithotomy (PCNL) is first-line treatment for large or complex renal calculi. The traditional papillary access is considered safer, while non-papillary access may offer procedural advantages. This systematic review and meta-analysis aims to evaluate the efficacy and safety of papillary versus non-papillary approaches in PCNL for the management of kidney stones.

Eligible studies were identified by searching the PubMed, Web of Science, Scopus, Embase, and the Cochrane Library databases for relevant reports published until November 2025. Outcome measures included stone-free rate (SFR), fluoroscopy time, operation time, blood loss, transfusion rates, change in serum creatinine, hospital stay, and complications. Risk ratio (RR), weighted mean difference (WMD) and standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects models. Two reviewers independently assessed the quality of all included studies, and statistical analyses were performed using R software.

Eight studies involving 985 patients were included, three of which were randomized controlled trials. Post-PCNL SFR showed no significant difference between the papillary and non-papillary approach groups (fixed-effects model: RR=1.01, 95% CI: 0.94 to 1.07, P=0.858). Similarly, no statistically significant differences were found between the two groups in transfusion rates (RR=1.32; 95% CI: 0.75 to 2.30; P=0.336), blood loss (WMD=0.11; 95% CI: -0.22 to 0.44; P=0.519), fluoroscopy time (WMD=0.15; 95% CI: -0.07 to 0.38; P=0.185), hospital stay (WMD= -0.01; 95% CI: -0.15 to 0.13; P=0.911), or changes in serum creatinine (WMD=0.00; 95% CI: -0.05 to 0.05; P=0.893). Moreover, complication rates were comparable between papillary access and non-papillary access. Although operative time was slightly longer in the papillary group (SMD=0.16; 95% CI: 0.03 to 0.29; P=0.014), this difference was clinically insignificant.

Both papillary and non-papillary access are suitable for most PCNL procedures, demonstrating comparable efficacy and safety. The optimal approach should be determined by patient anatomy and surgeon expertise.