Complications and outcomes of tubeless versus nephrostomy tube in percutaneous nephrolithotomy: a systematic review and meta-analysis of randomized clinical trials.
Vineet GauharOlivier TraxerEsther García RojoSimone ScarcellaMaria Pia PaviaVinson Wai-Shun ChanEugenio PretoreMarcelo Langer WroclawskiMariela CorralesHo Yee TiongEe Jean LimJeremy Yuen-Chun TeohChin-Tiong HengJean de la RosetteBhaskar Kuman SomaniDaniele CastellaniPublished in: Urolithiasis (2022)
We aimed to perform a systematic review of randomized trials to summarize the evidence on the safety and stone-free rate after Tubeless percutaneous nephrolithotomy (PCNL) (ureteral stent/catheter, no nephrostomy) compared to Standard PCNL (nephrostomy, with/without ureteral stent/catheter) to evaluate if the tubeless approach is better. The inverse variance of the mean difference with a random effect, 95% Confidence Interval (CI), and p values was used for continuous variables. Categorical variables were assessed using Cochran-Mantel-Haenszel method with the random effect model, and reported as Risk Ratio (RR), 95% CI, and p values. Statistical significance was set at p < 0.05 and a 95% CI. 26 studies were included. Mean operative time was significantly shorter in the Tubeless group (MD-5.18 min, 95% CI - 6.56, - 3.80, p < 0.00001). Mean postoperative length of stay was also significantly shorter in the Tubeless group (MD-1.10 day, 95% CI - 1.48, - 0.71, p < 0.00001). Incidence of blood transfusion, angioembolization for bleeding control, pain score at the first postoperative day, the number of patients requiring postoperative pain medication, fever, urinary infections, sepsis, perirenal fluid collection, pleural breach, hospital readmission, and SFR did not differ between the two groups. Incidence of postoperative urinary fistula was significantly lower in the Tubeless group (RR 0.18, 95% CI 0.07, 0.47, p = 0.0005). This systematic review shows that tubeless PCNL can be safely performed and the standout benefits are shorter operative time and hospital stay, and a lower rate of postoperative urinary fistula.
Keyphrases
- patients undergoing
- systematic review
- postoperative pain
- ultrasound guided
- risk factors
- healthcare
- end stage renal disease
- minimally invasive
- ejection fraction
- newly diagnosed
- chronic pain
- acute kidney injury
- adverse drug
- intensive care unit
- chronic kidney disease
- meta analyses
- emergency department
- pain management
- editorial comment
- type diabetes
- atrial fibrillation
- neuropathic pain
- acute care
- peritoneal dialysis
- weight loss
- patient reported outcomes
- insulin resistance
- skeletal muscle
- glycemic control
- double blind