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BMC Urology
Published in: BMC Urology 1/2017

Open Access 01-12-2017 | Research article

Tubeless versus standard percutaneous nephrolithotomy: an update meta-analysis

Authors: Yang Xun, Qing Wang, Henglong Hu, Yuchao Lu, Jiaqiao Zhang, Baolong Qin, Yudi Geng, Shaogang Wang

Published in: BMC Urology | Issue 1/2017

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Abstract

Background

To update a previously published systematic review and meta-analysis on the efficacy and safety of tubeless percutaneous nephrolithotomy (PCNL).

Methods

A systematic literature search of EMBASE, PubMed, Web of Science, and the Cochrane Library was performed to confirm relevant studies. The scientific literature was screened in accordance with the predetermined inclusion and exclusion criteria. After quality assessment and data extraction from the eligible studies, a meta-analysis was conducted using Stata SE 12.0.

Results

Fourteen randomized controlled trials (RCTs) involving 1148 patients were included. Combined results demonstrated that tubeless PCNL was significantly associated with shorter operative time (weighted mean difference [WMD], −3.79 min; 95% confidence interval [CI], −6.73 to −0.85; P = 0.012; I2 = 53.8%), shorter hospital stay (WMD, −1.27 days; 95% CI, −1.65 to −0.90; P < 0.001; I2 = 98.7%), faster time to return to normal activity (WMD, −4.24 days; 95% CI, −5.76 to −2.71; P < 0.001; I2 = 97.5%), lower postoperative pain scores (WMD, −16.55 mm; 95% CI, −21.60 to −11.50; P < 0.001; I2 = 95.7%), less postoperative analgesia requirements (standard mean difference, −1.09 mg; 95% CI, −1.35 to −0.84; P < 0.001; I2 = 46.8%), and lower urine leakage (Relative risk [RR], 0.30; 95% CI 0.15 to 0.59; P = 0.001; I2 = 41.2%). There were no significant differences in postoperative hemoglobin reduction (WMD, −0.02 g/dL; 95% CI, −0.04 to 0.01; P = 0.172; I2 = 41.5%), stone-free rate (RR, 1.01; 95% CI, 0.97 to 1.05; P = 0.776; I2 = 0.0%), postoperative fever rate (RR, 1.05; 95% CI, 0.57 to 1.93; P = 0.867; I2 = 0.0%), or blood transfusion rate (RR, 0.79; 95% CI, 0.36 to 1.70; P = 0.538; I2 = 0.0%). The results of subgroup analysis were consistent with the overall findings. The sensitivity analysis indicated that most results remained constant when total tubeless or partial tubeless or mini-PCNL studies were excluded respectively.

Conclusions

Tubeless PCNL is an available and safe option in carefully evaluated and selected patients. It is significantly associated with the advantages of shorter hospital stay, shorter time to return to normal activity, lower postoperative pain scores, less analgesia requirement, and reduced urine leakage.
Literature
1.
2.
Geraghty R, Jones P, Somani BK, et al. Worldwide trends of urinary stone disease treatment over the last two decades: a systematic review. J Endourol. 2017;31:547–56.CrossRefPubMed
3.
Ganpule AP, Vijayakumar M, Malpani A, et al. Percutaneous nephrolithotomy (PCNL) a critical review. Int J Surg. 2016;36:660–4.CrossRefPubMed
4.
5.
Bellman GC, Davidoff R, Candela J, et al. Tubeless percutaneous renal surgery. J Urol. 1997;157:1578–82.CrossRefPubMed
6.
Song G, Guo X, Niu G, et al. Advantages of tubeless mini-percutaneous nephrolithotomy in the treatment of preschool children under 3 years old. J Pediatr Surg. 2015;50:655–8.CrossRefPubMed
7.
Yuan H, Zheng S, Liu L, et al. The efficacy and safety of tubeless percutaneous nephrolithotomy: a systematic review and meta-analysis. Urol Res. 2011;39:401–10.CrossRefPubMed
8.
Wang J, Zhao C, Zhang C, et al. Tubeless vs standard percutaneous nephrolithotomy: a meta-analysis. BJU Int. 2012;109:918–24.CrossRefPubMed
9.
Zhong Q, Zheng C, Mo J, et al. Total tubeless versus standard percutaneous nephrolithotomy: a meta-analysis. J Endourol. 2013;27:420–6.CrossRefPubMed
10.
Mandhani A, Goyal R, Vijjan V, et al. Tubeless percutaneous nephrolithotomy -- should a stent be an integral part? J Urol. 2007;178:921–4.CrossRefPubMed
11.
Choi M, Brusky J, Weaver J, et al. Randomized trial comparing modified tubeless percutaneous nephrolithotomy with tailed stent with percutaneous nephrostomy with small-bore tube. J Endourol. 2006;20(10):766-70.
12.
Tefekli A, Altunrende F, Tepeler K, et al. Tubeless percutaneous nephrolithotomy in selected patients: a prospective randomized comparison. Int Urol Nephrol. 2007;39:57–63.CrossRefPubMed
13.
Singh I, Singh A, Mittal G. Tubeless percutaneous nephrolithotomy: is it really less morbid? J Endourol. 2008;22:427–34.CrossRefPubMed
14.
Shah HN, Sodha HS, Khandkar AA, et al. A randomized trial evaluating type of nephrostomy drainage after percutaneous nephrolithotomy: small bore v tubeless. J Endourol. 2008;22:1433–9.CrossRefPubMed
15.
Agrawal MS, Agrawal M, Gupta A, et al. A randomized comparison of tubeless and standard percutaneous nephrolithotomy. J Endourol. 2008;22:439–42.CrossRefPubMed
16.
Crook TJ, Lockyer CR, Keoghane SR, et al. A randomized controlled trial of nephrostomy placement versus tubeless percutaneous nephrolithotomy. J Urol. 2008;180:612–4.CrossRefPubMed
17.
Istanbulluoglu MO, Ozturk B, Gonen M, et al. Effectiveness of totally tubeless percutaneous nephrolithotomy in selected patients: a prospective randomized study. Int Urol Nephrol. 2009;41:541–5.CrossRefPubMed
18.
Aghamir SMK, Modaresi SS, Aloosh M, et al. Totally tubeless percutaneous nephrolithotomy for upper pole renal stone using subcostal access. J Endourol. 2011;25:583–6.CrossRefPubMed
19.
Chang CH, Wang CJ, Huang SW. Totally tubeless percutaneous nephrolithotomy: a prospective randomized controlled study. Urol Res. 2011;39:459–65.CrossRefPubMed
20.
Lu Y, Ping JG, Zhao XJ, et al. Randomized prospective trial of tubeless versus conventional minimally invasive percutaneous nephrolithotomy. World J Urol. 2013;31:1303–7.CrossRefPubMed
21.
Agrawal MS, Sharma M, Agarwal K. Tubeless percutaneous Nephrolithotomy using Antegrade tether: a randomized study. J Endourol. 2014;28:644–8.CrossRefPubMed
22.
Zhao PT, Hoenig DM, Smith AD, et al. A randomized controlled comparison of nephrostomy drainage vs ureteral stent following percutaneous nephrolithotomy using the Wisconsin stone QOL. J Endourol. 2016;30:1275–84.CrossRefPubMed
23.
Sebaey A, Khalil MM, Soliman T, et al. Standard versus tubeless mini-percutaneous nephrolithotomy: a randomised controlled trial. Arab journal of urology. 2016;14:18–23.CrossRefPubMedPubMedCentral
24.
Kumar S, Singh S, Singh P, et al. Day care PNL using 'Santosh-PGI hemostatic seal' versus standard PNL: a randomized controlled study. Cent European J Urol. 2016;69:190–7.PubMedPubMedCentral
25.
26.
27.
28.
29.
30.
Ferakis N, Stavropoulos M. Mini percutaneous nephrolithotomy in the treatment of renal and upper ureteral stones: lessons learned from a review of the literature. Urology annals. 2015;7:141–8.CrossRefPubMedPubMedCentral
31.
32.
Segura JW, Patterson DE, LeRoy AJ, et al. Percutaneous removal of kidney stones: review of 1,000 cases. J Urol. 1985;134:1077–81.CrossRefPubMed
33.
Skolarikos A, Alivizatos G, de la Rosette JJMC. Percutaneous nephrolithotomy and its legacy. Eur Urol. 2005; 47:22–28.CrossRefPubMed
34.
Maheshwari PN, Andankar MG, Bansal M. Nephrostomy tube after percutaneous nephrolithotomy: large-bore or pigtail catheter? J Endourol. 2000;14:735–7. 737-8CrossRefPubMed
35.
Abbott JE, Deem SG, Mosley N, et al. Are we fearful of tubeless percutaneous nephrolithotomy? Assessing the need for tube drainage following percutaneous nephrolithotomy. Urology annals. 2016;8:70–5.CrossRefPubMedPubMedCentral
36.
Pietrow PK, Auge BK, Lallas CD, et al. Pain after percutaneous nephrolithotomy: impact of nephrostomy tube size. J Endourol. 2003;17(6):411–4.CrossRefPubMed
37.
Shoma AM, Elshal AM. Nephrostomy tube placement after percutaneous nephrolithotomy: critical evaluation through a prospective randomized study. Urology. 2012;79:771–6.CrossRefPubMed
38.
Ni S, Qiyin C, Tao W, et al. Tubeless percutaneous nephrolithotomy is associated with less pain and shorter hospitalization compared with standard or small bore drainage: a meta-analysis of randomized controlled trials. Urology. 2011;77:1293–8.CrossRefPubMed
39.
Kara C, Resorlu B, Bayindir M, et al. A randomized comparison of totally tubeless and standard percutaneous nephrolithotomy in elderly patients. Urology. 2010;76:289–93.CrossRefPubMed
40.
Proietti S, Knoll T, Giusti G. Contemporary ureteroscopic management of renal stones. Int J Surg. 2016;36:681–7.CrossRefPubMed
41.
de Cogain MR, Krambeck AE. Advances in tubeless percutaneous nephrolithotomy and patient selection: an update. Current urology reports. 2013;14:130–7.CrossRefPubMed
42.
Shah HN, Hegde S, Shah JN, et al. A prospective, randomized trial evaluating the safety and efficacy of fibrin sealant in tubeless percutaneous nephrolithotomy. J Urol. 2006;176:2488–92.CrossRefPubMed
43.
Zilberman DE, Lipkin ME, de la Rosette JJ, et al. Tubeless percutaneous nephrolithotomy--the new standard of care? J Urol. 2010;184:1261–6.CrossRefPubMed
44.
Limb J, Bellman GC. Tubeless percutaneous renal surgery: review of first 112 patients. Urology. 2002;59:527–31.CrossRefPubMed
45.
Istanbulluoglu MO, Ozturk B, Cicek T, et al. Bilateral simultaneous totally tubeless percutaneous nephrolithotomy: preliminary report of six cases. J Endourol. 2009;23(8):1255–7.CrossRefPubMed
46.
Bagrodia A, Raman JD, Bensalah K, et al. Synchronous bilateral percutaneous nephrostolithotomy: analysis of clinical outcomes, cost and surgeon reimbursement. J Urol. 2009;181(1):149–53.CrossRefPubMed
Metadata
Title
Tubeless versus standard percutaneous nephrolithotomy: an update meta-analysis
Authors
Yang Xun
Qing Wang
Henglong Hu
Yuchao Lu
Jiaqiao Zhang
Baolong Qin
Yudi Geng
Shaogang Wang
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Urology / Issue 1/2017
Electronic ISSN: 1471-2490
DOI
https://doi.org/10.1186/s12894-017-0295-2

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