The impact of size: a systematic review and meta-analysis of tubeless versus standard percutaneous nephrolithotomy in 2171 adult patients.

PURPOSE: Percutaneous nephrolithotomy (PCNL) with nephrostomy drainage remains the standard treatment for large and complex renal calculi; however, the comparative effectiveness of tubeless PCNL versus standard PCNL, particularly across different nephrostomy tube sizes, remains uncertain.This meta-analysis focuses on comparing T-PCNL versus S-PCNL across nephrostomy bore sizes to provide a comprehensive evaluation of outcomes.

METHODS

We conducted a comprehensive database search until July 2024, focusing on randomized controlled trials (RCTs) that compared T-PCNL and S-PCNL. We included studies that reported outcomes related to operative time, stone-free rate (SFR), post-operative complications, and length of hospital stay. Results were expressed as standardized mean differences (SMD), mean differences (MD), and risk ratios (RR), with 95% confidence intervals (CI).

RESULTS

Twenty-eight RCTs comprising 2,171 patients were included. T-PCNL significantly reduced hospital stay (SMD = -1.12; p < 0.00001), analgesic use (SMD = -1.01; p < 0.00001), and postoperative pain (SMD = -1.05; p = 0.01), particularly when compared to medium and large bore tubes. No significant differences were found in SFR (RR = 1.03; p = 0.15), transfusion, urosepsis, or Clavien-Dindo grade II-IV events. Operative time and residual stone burden were also lower with T-PCNL.

CONCLUSION

T-PCNL is a safe and effective alternative to S-PCNL, offering faster recovery and fewer postoperative symptoms. Its benefits are most pronounced when compared to larger bore nephrostomy tubes, supporting its broader adoption in appropriately selected patients.