Intraoperative and postoperative feasibility and safety of total tubeless, tubeless, small-bore tube, and standard percutaneous nephrolithotomy: a systematic review and network meta-analysis of 16 randomized controlled trialsReport as inadecuate




Intraoperative and postoperative feasibility and safety of total tubeless, tubeless, small-bore tube, and standard percutaneous nephrolithotomy: a systematic review and network meta-analysis of 16 randomized controlled trials - Download this document for free, or read online. Document in PDF available to download.

BMC Urology

, 17:48

Endourology and technology

Abstract

BackgroundPercutaneous nephrolithotomy PCNL is performed to treat relatively large renal stones. Recent publications indicate that tubeless and total tubeless stentless PCNL is safe in selected patients. We performed a systematic review and network meta-analysis to evaluate the feasibility and safety of different PCNL procedures, including total tubeless, tubeless with stent, small-bore tube, and large-bore tube PCNLs.

MethodsPubMed, Cochrane Central Register of Controlled Trials, and EMBASE™ databases were searched to identify randomized controlled trials published before December 30, 2013. One researcher examined all titles and abstracts found by the searches. Two investigators independently evaluated the full-text articles to determine whether those met the inclusion criteria. Qualities of included studies were rated with Cochrane’s risk-of-bias assessment tool.

ResultsSixteen studies were included in the final syntheses including pairwise and network meta-analyses. Operation time, pain scores, and transfusion rates were not significantly different between PCNL procedures. Network meta-analyses demonstrated that for hemoglobin changes, total tubeless PCNL may be superior to standard PCNL mean difference MD 0.65, 95% CI 0.14–1.13 and tubeless PCNLs with stent MD -1.14, 95% CI -1.65–-0.62, and small-bore PCNL may be superior to tubeless PCNL with stent MD 1.30, 95% CI 0.27–2.26. Network meta-analyses also showed that for length of hospital stay, total tubeless MD 1.33, 95% CI 0.23–2.43 and tubeless PCNLs with stent MD 0.99, 95% CI 0.19–1.79 may be superior to standard PCNL. In rank probability tests, small-bore tube and total tubeless PCNLs were superior for operation time, pain scores, and hemoglobin changes.

ConclusionsFor hemoglobin changes, total tubeless and small-bore PCNLs may be superior to other methods. For hospital stay, total tubeless and tubeless PCNLs with stent may be superior to other procedures.

KeywordsCalculi Lithotripsy Nephrostomy Percutaneous Meta-analysis Bayes theorem AbbreviationsPCNLPercutaneous nephrolithotomy

RCTRandomized controlled trial

VASVisual analogue scale

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