Total Tubeless Versus Standard Percutaneous Nephrolithotomy:A Meta-analysis

Purpose To compare the safety and efficacy of total tubeless percutaneous nephrolithotomy(PCNL)with the standard PCNL for the treatment of upper urinary calculi.Materials and Methods PubMed,EMBASE,Cochrane Library and ScienceDirect were searched for collecting related literatures on two procedures.All compared studies,including randomized controlled trials(RCT),cohort studies(CS)and case-control studies(CCS),were included.Results Totally,14 studies were included.Pooled data demonstrated that patients underwent total tubeless PCNL were associated with significantly shorter operation time [weighted mean difference(WMD):-3.41,P = 0.004],shorter hospital stay(WMD:-1.54,P < 0.00001).It seemed that significantly less postoperative analgesic requirement could be found in total tubeless PCNL group according to subgroup analysis.However,no significant differences could be found between the two groups in stone-free rate [risk ratio(RR): 1.03,P = 0.26],the hemoglobin drop(WMD:-0.03,P = 0.85),and rates of postoperative fever(RR: 0.53,P = 0.11)and transfusion(RR: 0.79,P = 0.41).Sensitivity analysis after excluding CCS revealed similar results with previous findings.Conclusions Total tubeless PCNL would be superior to the standard one in reducing operation time,hospital stay and postoperative analgesic requirement without significantly more adverse events.