Tubless Versrs Conventional Percutaneous Nephrolithotomy For Patients With Renal Calculus: A Meta-Analysis

Objective To assess the therapeutic effect of tubeless Percutaneous Nephrolithotomy (PCNL) versus conventional PCNL and offer guidance for clinical practice.Methods Randomized controlled trials (RCTs) comparing tubeless PCNL versus conventional PCNL were identified from PUBMED, EMBASE, LILACS, Cochrance Library, Chinese BioMedical Literature Database(CBM) , China National Knowledge Infrastructure(CNKI) and databases of undisclosed literatures such as OpenSIGLE and PQDD. We hand-searched the reference lists of all related articles for additional publications. The analyzed outcomes were stone-free rate, operative time, blood loss, analgesic requirement, complications, hospitalization time and expenditure, recovery time for working and calculus recurrence rate. Statistical analysis was porformed with STATA 11.0.Results 12 RCTs involving 689 patients were included. The stone-free rate (RR=1.072,95%CI=0.978 to 1.175,P=0.136), bleeding (RR=0.987,95%CI=0.903 to 1.079 , P = 0.773), postoperative fever (RR=0.991 ,95%CI=0.941 to 1.044 , P = 0.728) and urinary tract infection (UTI) (RR=0.953,95%CI=0.867 to 1.047,P = 0.315) did not statistically significant differ between the tubeless and conventional groups. Less urinary leakage (SMD=-2.243,95%CI= -4.129 to -0.357,P =0.020) in tubeless group were identified. Subgroups analysis: a) Operation time: There was not statistically significant difference in operation time between the tubeless plus a D-J stent and conventional PCNL(SMD =0.041,95%CI=-0.206 to 0.288,P =0.743), but it is statistically significantly shorter(SMD =-0.815,95%CI= -1.449 to -0.181,P =0.012) when D-J stent was also avoided. b) Pain score (VAS): Tubeless failed to reduce the VAS score in European/American patients(SMD = 0.197,95%CI= -0.200 to 0.593,P = 0.330) but effective in Asia patients(P <0.001-P <0.05). c) Analgesic requirement: Both morphine group(SMD =-1.189,95%CI=-2.336 to -0.043,P = 0.042) and diclofenac sodium group(SMD=-1.056,95%CI= -1.966 to -0.147,P = 0.023) showed less analgesic requirement with a statistically significant difference. The hospitalization time was not pooled for potential clinical heterogeneity that was reported shorter in tubeless group by 9 studies and no statistically significant difference in two groups by 3.Conclusions Tubeless PCNL is effective and safe compared with conventional PCNL and it has the advantages of less hospitalization time and analgesic requirement.