Intraoperative and postoperative feasibility and safety of total tubeless, tubeless, small-bore tube, and standard percutaneous nephrolithotomy: a systematic review and network meta-analysis of 16 randomized controlled trials

• Published in: BMC urology 2017-06, Vol.17 (1), p.48-48, Article 48
• Main Authors: Lee, Joo Yong, Jeh, Seong Uk, Kim, Man Deuk, Kang, Dong Hyuk, Kwon, Jong Kyou, Ham, Won Sik, Choi, Young Deuk, Cho, Kang Su
• Format: Article
• Language: English
• Subjects: Analysis; Bayes theorem; Bias; Calculi; Care and treatment; Catheters; Clinical trials; Feasibility Studies; Hemoglobin; Humans; Implants; Intraoperative Care - instrumentation; Intraoperative Care - methods; Kidney Calculi - diagnosis; Kidney Calculi - surgery; Kidney stones; Kidneys; Length of Stay - trends; Lithotripsy; Markov analysis; Meta-analysis; Nephrolithotomy, Percutaneous - instrumentation; Nephrolithotomy, Percutaneous - methods; Nephrostomy; Network Meta-Analysis; Pain; Percutaneous; Percutaneous nephrostomy; Physiological aspects; Postoperative Care - instrumentation; Postoperative Care - methods; Randomized Controlled Trials as Topic - methods; Researchers; Retrospective Studies; Studies; Surgery; Treatment Outcome; Urine; Urology
• ISSN: 1471-2490; 1471-2490
• DOI: 10.1186/s12894-017-0239-x

Percutaneous nephrolithotomy (PCNL) is performed to treat relatively large renal stones. Recent publications indicate that tubeless and total tubeless (stentless) PCNL is safe in selected patients. We performed a systematic review and network meta-analysis to evaluate the feasibility and safety of different PCNL procedures, including total tubeless, tubeless with stent, small-bore tube, and large-bore tube PCNLs. PubMed, Cochrane Central Register of Controlled Trials, and EMBASE™ databases were searched to identify randomized controlled trials published before December 30, 2013. One researcher examined all titles and abstracts found by the searches. Two investigators independently evaluated the full-text articles to determine whether those met the inclusion criteria. Qualities of included studies were rated with Cochrane's risk-of-bias assessment tool. Sixteen studies were included in the final syntheses including pairwise and network meta-analyses. Operation time, pain scores, and transfusion rates were not significantly different between PCNL procedures. Network meta-analyses demonstrated that for hemoglobin changes, total tubeless PCNL may be superior to standard PCNL (mean difference [MD] 0.65, 95% CI 0.14-1.13) and tubeless PCNLs with stent (MD -1.14, 95% CI -1.65--0.62), and small-bore PCNL may be superior to tubeless PCNL with stent (MD 1.30, 95% CI 0.27-2.26). Network meta-analyses also showed that for length of hospital stay, total tubeless (MD 1.33, 95% CI 0.23-2.43) and tubeless PCNLs with stent (MD 0.99, 95% CI 0.19-1.79) may be superior to standard PCNL. In rank probability tests, small-bore tube and total tubeless PCNLs were superior for operation time, pain scores, and hemoglobin changes. For hemoglobin changes, total tubeless and small-bore PCNLs may be superior to other methods. For hospital stay, total tubeless and tubeless PCNLs with stent may be superior to other procedures.