Totally tubeless percutaneous nephrolithotomy versus standard percutaneous nephrolithotomy in the treatment of renal stones: An updated systematic review and meta-analysis.
Mudasar Nisar, Rabia Javed Iqbal, Muhammad Mujtaba Rasool et al.
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In 30 seconds
This updated systematic review and meta-analysis compared totally tubeless with standard percutaneous nephrolithotomy (PCNL) for renal stones. It included 21 studies and 2,837 patients. Stone-free rates were comparable (RR = 1.02, 95% CI = 0.95-1.10, p = 0.51), while totally tubeless PCNL was associated with shorter operative time and hospital stay and fewer total complications. Hemoglobin drop and blood transfusion rates did not differ significantly. The findings suggest similar stone clearance with some perioperative advantages for the totally tubeless approach.
Key findings
- Totally tubeless PCNL was associated with shorter operative time (WMD = -7.96, 95% CI = -12.95 to -2.98, p < 0.01).
- Hospital stay was shorter with totally tubeless PCNL (WMD = -1.53, 95% CI = -2.12 to -0.93, p < 0.01).
- Stone-free rates were comparable between techniques (RR = 1.02, 95% CI = 0.95-1.10, p = 0.51).
- Total complications were lower with totally tubeless PCNL (RR: 0.63, 95% CI: 0.44-0.90, p = 0.02); hemoglobin drop and transfusion rates did not differ significantly.
Why it matters
The review suggests that omitting both a postoperative ureteric stent and nephrostomy tube can be associated with shorter procedures and admissions without an apparent reduction in stone-free efficacy. The complication finding may also inform consideration of this approach, while the pooled comparisons do not establish that it is suitable for every patient or clinical setting.