Intrarenal pressure and clinical outcomes during suction-assisted versus conventional percutaneous nephrolithotomy: a systematic review and meta-analysis.

OBJECTIVE

Elevated intrarenal pressure (IRP) during percutaneous nephrolithotomy (PCNL) is linked to postoperative infectious morbidity. This systematic review and meta-analysis evaluated suction-assisted PCNL versus conventional PCNL regarding IRP and clinical outcomes.

METHODS

Registered in PROSPERO (CRD420251235580), this study followed PRISMA guidelines. Primary outcome was IRP; secondary outcomes included postoperative fever, sepsis, Clavien-Dindo ≥ 2 complications, operative time, hospital stay, and stone-free rate. Random-effects models and I2 statistics were used. Bias was assessed via Cochrane ROB-2 and ROBINS-I tools.

RESULTS

Eight studies involving 1,171 patients (577 suction-assisted; 594 conventional) were included. Quantitative synthesis of six studies showed suction-assisted PCNL maintained significantly lower IRP (2.7-16.9 mmHg) compared to conventional groups (15.4 to > 30 mmHg), effectively preventing prolonged episodes of ≥ 30 mmHg. Suction-assisted PCNL was associated with significantly lower risks of postoperative fever and Clavien-Dindo ≥ 2 complications. Pooled analysis suggested reduced sepsis risk, though confidence intervals were wide due to low event rates. Suction cohorts reported no pressure-related severe infections. Additionally, suction-assisted PCNL demonstrated shorter operative times, shorter hospital stays, and higher stone-free rates. Heterogeneity was low to moderate across most outcomes.

CONCLUSIONS

Suction-assisted PCNL provides superior IRP control and more favorable perioperative outcomes than conventional PCNL. While these systems appear to reduce infectious morbidity and complications, additional high-quality randomized controlled trials are required for confirmation.