Tubeless vs standard percutaneous nephrolithotomy: a meta‐analysis

• Published in: BJU international 2012-03, Vol.109 (6), p.918-924
• Main Authors: Wang, Jiawu, Zhao, Chunlei, Zhang, Chengyao, Fan, Xiaodong, Lin, Yanjun, Jiang, Qing
• Format: Article
• Language: English
• Subjects: Analgesia; Analgesia - statistics & numerical data; Biological and medical sciences; Clinical trials; Hospitals; Humans; Kidney Calculi - surgery; Language; Length of Stay - statistics & numerical data; Medical sciences; meta‐analysis; Nephrology. Urinary tract diseases; Nephrostomy, Percutaneous - adverse effects; Nephrostomy, Percutaneous - methods; Pain perception; Pain, Postoperative - etiology; percutaneous nephrolithotomy; Randomized Controlled Trials as Topic; Reviews; Studies; Surgery; Time Factors; Treatment Outcome; tubeless
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2011.10463.x

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? This study showed that tubeless PCNL could reduce hospital stay with little need for postoperative analgesia. This study discussed the clinical feasibility of tubeless PCNL, which is the tendency of PCNL. Our results are reliable by using veta‐analysis from individual studies. OBJECTIVE •  To systematically review and compare tubeless percutaneous nephrolithotomy (PCNL) with standard PCNL. MATERIALS AND METHODS •  We conducted a review of the English language literature on studies involving randomized controlled trials for PCNL. The studies chosen to be included in our review compared tubeless PCNL with standard PCNL and described the advantages of each in the outcomes. •  Two reviewers independently screened the studies for eligibility, evaluated their quality and extracted the data from the eligible studies, with confirmation by cross‐checking. •  Data were processed using RevMan 5.0. RESULTS •  Seven studies involving 1365 cases met the inclusion criteria, and these were included in the meta‐analysis. •  The patients' baseline characteristics were comparable in all the studies. By comparing the four common characteristics, we found no difference in efficacy between the two surgical approaches in terms of mean operation duration and postoperative haematocrit change (P > 0.05). •  We found that the mean analgesic requirement and number of days in hospital were lower for tubeless PCNL (P < 0.05). CONCLUSIONS •  Our results show that tubeless PCNL is a good option in non‐complicated cases, with the advantages of reduced hospital stay and little need for postoperative analgesia. There was no difference between the two approaches in operation duration, or haematocrit change after surgery. •  As only few studies with small study populations were available, more high quality larger trials with longer follow‐up are recommended.