The impact of size: a systematic review and meta-analysis of tubeless versus standard percutaneous nephrolithotomy in 2171 adult patients.
Andrea G Palacios-Navas, Luis A Esparza-Miranda, Arath J Campos-Muñoz et al.
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In 30 seconds
This systematic review and meta-analysis compared tubeless with standard percutaneous nephrolithotomy (PCNL) in adults with renal calculi, drawing on 28 randomised controlled trials and 2,171 patients. Tubeless PCNL was associated with shorter hospital stay (SMD = -1.12; p < 0.00001), less analgesic use and postoperative pain, with benefits particularly evident versus medium- and large-bore tubes. Stone-free rates did not differ significantly (RR = 1.03; p = 0.15), nor did transfusion, urosepsis, or Clavien-Dindo grade II-IV events. Operative time and residual stone burden were also lower with tubeless PCNL.
Key findings
- Tubeless PCNL reduced hospital stay (SMD = -1.12; p < 0.00001), particularly compared with medium- and large-bore nephrostomy tubes.
- Analgesic use (SMD = -1.01; p < 0.00001) and postoperative pain (SMD = -1.05; p = 0.01) were lower with tubeless PCNL.
- Stone-free rates were not significantly different (RR = 1.03; p = 0.15); transfusion, urosepsis, and Clavien-Dindo grade II-IV events also showed no significant differences.
- Operative time and residual stone burden were lower with tubeless PCNL.
Why it matters
The findings suggest that omitting nephrostomy drainage can reduce postoperative symptoms and hospital stay without a detected loss in stone-free rate or increase in several reported complications. The apparent greater benefit against larger-bore tubes highlights that the comparator’s tube size may matter when interpreting PCNL outcomes.