Total Tubeless Versus Standard Percutaneous Nephrolithotomy: A Meta Analysis

Objective The aim of this meta-analysis was to evaluate the efficacyand safety of total tubeless percutaneous nephrolithotomy (PCNL) versusstandard PCNL.Method MEDLINE, EMBASE, the Cochrane Central Register ofControlled Trails, and the Chinese Biomedical Literature Database wereresearched. Randomized controlled trails and clinical controlled trailscomparing total tubeless PCNL versus standard PCNL were included in thisreview. Two reviewers independently assessed trail eligibility and quality,and extracted data. Meta-analysis was performed with RevMan5.1.Outcome There were five randomized controlled trails and five clinicalcontrolled trails were included, involving a total of709patients. All patientswere divided into total tubeless PCNL group and standard PCNL group. Thepooled results showed that the total tubeless PCNL group was significantlyreduced the operation time[WMD-4.7395%CI-8.95,-0.52P=0.03],hospital stay [WMD-1.3195%CI-1.70,-0.91P<0.00001], andanalgesic requirement[SWD-0.6995%CI-1.05,-0.32P=0.0002]. There was no statistically significant difference in the mean hemoglobin decrease[WMD-0.0795%CI-0.20,-0.06P=0.27], fever [RR0.5995%CI-0.20,-1.73P=0.34], transfusion[RR0.8295%CI0.40,1.70P=0.60],prolonged urinary drainage [RR0.58,95%CI（0.08,4.09）P=0.59] andancillary procedure [ESWL RR0.84,95%CI （0.29,2.41） P=0.74,second-look PCNL RR1.18,95%CI（0.49,2.89）P=0.71].Conclusion Total tubeless PCNL is safe and effective procedure. Itsignificantly reduced the hospital stay, analgesic requirement and the time toreturn to normal activity without increasing complications. However, betterand larger randomized trials are needed to confirm these findings.