This systematic review was designed to evaluate the efficacy of tubeless percutaneous nephrolithotomy (PCNL) versus standard percutaneous nephrolithotomy (PCNL) for kidney stones. Computerized search was performed for randomized clinical trials (RCTs) from PubMed, EMBASE, CENTRAL and Cochrane Database of Systematic Reviews databases. The included studies were randomized trials investigating tubeless PCNL versus standard PCNL in patients with kidney stones. Outcomes measured included postoperative pain, postoperative analgesia, hospital stay, drop in hemoglobin, stone free, urine leakage, blood transfusion, or pyrexia per randomized patients. In all, 15 RCTs involving 947 subjects were included. With regard to postoperative pain, analgesia, hospital stay and urine leakage, it was significantly reduced in tubeless PCNL group. In respect of drop in hemoglobin, stone free, blood transfusion and pyrexia, tubeless PCNL group appeared to be equivalent with standard PCNL group. Tubeless PCNL technology is associated with shorter hospitalization time, lower incidence of postoperative pain and less analgesia requirement after nephrolithotony. Tubeless PCNL can be used as a substitute for traditional standard PCNL of the first-line treatment. Nevertheless, further research in this field is urgently needed to confirm it.
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Article Synopsis
- This study compares the safety and effectiveness of flexible ureteroscopy (f-URS) and ambulatory tubeless mini-percutaneous nephrolithotomy (mini-PCNL) for treating 1-2 cm lower calyceal renal stones in a randomized controlled trial involving 72 patients.
- Results show that mini-PCNL had a longer operative time but significantly higher stone-free rates (SFR) at both postoperative Day 1 and three months later compared to f-URS.
- Both procedures had similar postoperative complications, but two patients in the f-URS group required re-treatment, highlighting the need to assess the best surgical approach for specific cases.
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