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

Objectives To 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. Methods All 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. Results Ten 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. Conclusions Tubeless PCNL is associated with less pain and quicker recovery compared with standard or small-bore PCNL, in the management of uncomplicated renal calculi.