Totally tubeless percutaneous nephrolithotomy versus standard percutaneous nephrolithotomy in the treatment of renal stones: An updated systematic review and meta-analysis

Abstract

Background:

Percutaneous nephrolithotomy (PCNL) is a standard surgical procedure for kidney stone removal. Totally tubeless PCNL is a variation in technique in which neither an indwelling ureteric stent nor a nephrostomy tube is placed postoperatively. This meta-analysis compares the efficacy and safety of totally tubeless PCNL with standard PCNL.

Methods:

PubMed, Scopus, Cochrane Library, and clinicaltrials.gov databases were searched until January 2025. The primary outcomes were stone-free rate, operative time and hospital stay while secondary outcomes were hemoglobin (Hb) drop, total complication rates and blood transfusion. Effect sizes were calculated using fixed and random-effects models, expressed as mean difference (MD) or risk ratio (RR) with 95% confidence intervals (CIs).

Results:

21 studies with 2837 patients were included in this study. Totally tubeless PCNL was associated with significantly shorter operative time (WMD) = −7.96, 95% CI = −12.95 to −2.98, p < 0.01) and reduced hospital stay (WMD = −1.53, 95% CI = −2.12 to −0.93, p < 0.01). The stone-free rate was comparable between the two techniques (RR = 1.02, 95% CI = 0.95–1.10, p = 0.51). A significant reduction in total complications was observed in the totally tubeless group (RR: 0.63, 95% CI: 0.44–0.90, p = 0.02). However, no significant differences were observed in terms of hemoglobin drop (WMD: –0.36, 95% CI: –0.79 to 0.08, p = 0.11) or blood transfusion rates (RR: 0.77, 95% CI: 0.45–1.32, p = 0.30). Meta-regression suggested that stone size was not a significant predictor of procedural success or duration.

Conclusion:

Compared to standard PCNL, totally tubeless PCNL shortens operation time and hospital stay and lowers complication rates, with equivalent stone-free efficacy. These findings support its use as a preferred technique for appropriately selected patients.