Tubeless Percutaneous Nephrolithotomy is Associated With Less Pain and Shorter Hospitalization Compared with Standard or Small Bore Drainage: A Meta-analysis of Randomized, Controlled Trials

ObjectivesTo assess the efficacy and safety of tubeless percutaneous nephrolithotomy (PCNL) compared with standard or small-bore PCNL with a meta-analysis of randomized, controlled trials.MethodsAll eligible studies were searched on MEDLINE, Embase, and the Cochrane Library databases. Risk ratio (RR), mean difference, or standardized mean difference (SMD), with its 95% CI, was used to evaluate the size effect.ResultsTen and 3 trials were identified for comparison I (tubeless PCNL vs standard PCNL, 320 cases and 323 controls) and comparison II (tubeless PCNL vs small-bore PCNL, 55 cases and 54 controls), respectively. Tubeless PCNL required significantly less analgesia relative to standard PCNL (SMD −1.72; 95% CI −2.30 to 1.13; Pheterogeneity = 0.04) and small-pore PCNL (SMD −0.69; 95% CI −1.13 to 2.05; Pheterogeneity = 0.94). Furthermore, there was a remarkably shorter hospital stay in comparison I (SMD −1.35; 95% CI −1.40 to 1.30; Pheterogeneity = 0.60) and comparison II (SMD −0.49; 95% CI −0.76 to 0.21; Pheterogeneity = 0.15). The return to normal activity days was also significantly decreased in comparison I (SMD −4.34; 95% CI −6.28 to 2.41; Pheterogeneity = 0.02). However, no significant difference was observed in the analyses concerning stone-free blood transfusion and complications rate in both comparisons. In subgroup analyses by nephrostomy diameter (22-Fr) and drainage methods, most results were consistent with the overall findings except for that to evaluate the operative time in the double-J stent subgroup.ConclusionsTubeless PCNL is associated with less pain and quicker recovery compared with standard or small-bore PCNL, in the management of uncomplicated renal calculi.