Background
Methods
Literature search
Selection criteria
Data extraction
Assessment of quality
Statistical analysis
Results
Study characteristics
Study | year | nation | study design | Level of evidence | PCNL (tubeless/standard) | Drainage (Size of tube) | Sample size | Age(Year) | Sex (M/F) | Outcome measures |
---|---|---|---|---|---|---|---|---|---|---|
Kumar | 2016 | India | RCT | Level 2 | Total tubeless | – | 56 | 36.20 ± 13.32 | 33/23 | 1, 2, 3, 4, 5, |
Nephrostomy tube | 18F | 57 | 36.00 ± 11.82 | 31/26 | 6, 7, 8, 9, 10 | |||||
Sebaey | 2016 | Egypt | RCT | Level 2 | External ureteric catheter | 6F | 40 | 40.6 ± 11.9 | 31/9 | 1, 2, 3, |
Nephrostomy tube | 14F | 40 | 46.1 ± 18.4 | 27/13 | 5, 6, 10 | |||||
Zhao | 2016 | American | RCT | Level 2 | Double-J ureteral stent | – | 15 | 54.7 ± 12.2 | 9/6 | 1, 2, 3, 5, |
Nephrostomy tube | 8F/10F | 15 | 58.3 ± 17.6 | 8/7 | 6, 8, 9 | |||||
Agrawal | 2014 | India | RCT | Level 2 | Double-J ureteral stent | 5F/26cm | 83 | 33 (18–55) | 62/21 | 1, 3, 4, 5, |
Nephrostomy tube | 12F | 83 | 31 (21–57) | 59/24 | 6, 7, 8, 9, 10 | |||||
Lu | 2013 | China | RCT | Level 2 | External ureteric catheter | F5 | 16 | 43.81 ± 18.89 | 6/10 | 1, 2, 3, |
Nephrostomy tube+ Double-J ureteral stent | F16 + F6 | 16 | 46.25 ± 22.37 | 7/9 | 5, 9, 10 | |||||
Chang | 2011 | Taiwan | RCT | Level 2 | Total tubeless | – | 68 | 59.22 ± 12.44 | 51/17 | 1, 2, 3, 4, |
Nephrostomy tube + Double-J ureteral stent | F20 + F7 | 63 | 58.70 ± 10.85 | 50/13 | 5, 6, 7, 10 | |||||
Aghamir | 2011 | Iran | RCT | Level 2 | Total tubeless | – | 35 | 38.4 ± 11.7 | 23/12 | 1, 2, 3, 4, |
Nephrostomy tube + Double-J ureteral stent | NA | 35 | 40 ± 11.95 | 21/14 | 5, 6, 8 | |||||
Istanbulluoglu | 2009 | Turkey | RCT | Level 2 | Total tubeless | – | 45 | 47.48 ± 13.04 | 25/20 | 1, 2, 3, 5, |
Nephrostomy tube | 14F | 45 | 43.91 ± 14.44 | 24/21 | 6, 8, 9, 10 | |||||
Crook | 2008 | The United Kingdom | RCT | Level 2 | Total tubeless | – | 25 | 53 | 15/10 | 1, 3, 5, 6, 8 |
Nephrostomy tube | 26F | 25 | 52 | 19/6 | ||||||
Singh | 2008 | India | RCT | Level 2 | Double-J ureteral stent | NA | 30 | 31 (14–55) | 14/16 | 1, 2, 3, 4, |
Nephrostomy tube | 22F | 30 | 34 (17–55) | 15/15 | 5, 6, 7, 8, 10 | |||||
Shah | 2008 | India | RCT | Level 2 | Double-J ureteral stent | 6F | 33 | 44.18 ± 13.13 | 20/13 | 1, 2, 3, 5, |
Nephrostomy tube | 8F | 32 | 46.69 ± 12.46 | 21/11 | 6, 7, 8, 9, 10 | |||||
Agrawal, Madhu S | 2008 | India | RCT | Level 2 | Double-J ureteral stent | 6F/26cm | 101 | 33 (18–55) | 76/25 | 1, 3, 4, 5, |
Nephrostomy tube | 16F | 101 | 31 (21–57) | 76/25 | 6, 7, 8, 9, 10 | |||||
Tefekli | 2007 | Turkey | RCT | Level 2 | External ureteric catheter | 5F | 17 | 38.4 ± 12.3 | 8/9 | 1, 2, 3, |
Nephrostomy tube | 14-F | 18 | 41.3 ± 14.7 | 11/7 | 5, 6 | |||||
Choi | 2006 | American | RCT | Level 2 | Double-J ureteral stent | 6F | 12 | 52.9 ± 14 | NA | 2, 3, 4, |
Nephrostomy tube | 8.2F | 12 | 47 ± 16 | NA | 6, 7, 8 |
Study | PCNL (tubeless/standard) | Stone burden | Stone location | Stone composition |
---|---|---|---|---|
Kumar | TB | 30.2 ± 4.6 mm | Pelvic (35) Calyceal (15) Pelvic + Calyceal (6) | NA |
SD | 29.5 ± 4.2 mm | Pelvic (20) Calyceal (24) Pelvic + Calyceal (13) | NA | |
Sebaey | TB | 1.82 ± 0.36 cm | Renal pelvis (9) Lower calyx (25) Middle calyx (5) Upper calyx (1) | NA |
SD | 1.91 ± 0.37 cm | Renal pelvis (8) Lower calyx (25) Middle calyx (5) Upper calyx (2) | NA | |
Zhao | TB | 259.0 mm2
| NA | Primarily calcium oxalate (53.3%) Mixed calcium (26.7%) Primarily uric acid (20%) Struvite (0%) |
SD | 276.6 mm2
| NA | Primarily calcium oxalate (40%) Mixed calcium (20%) Primarily uric acid (33.3%) Struvite (6.7%) | |
Agrawal | TB | 3.8 (1.0–5.7) cm2
| NA | NA |
SD | 3.6 (1.1–5.3) cm2
| NA | NA | |
Lu | TB | 3.11 ± 0.62 cm | NA | NA |
SD | 3.29 ± 0.54 cm | NA | NA | |
Chang | TB | Length 24.74 ± 2.69 mm Width 16.40 ± 3.65 mm | NA | Struvite + apatite (8–11.8%) Uric acid (0%) Whewellite (30–44.1%) Whewellite + apatite (13–19.1%) Weddellite (17–25%) |
SD | Length 24.86 ± 2.78 mm Width 15.29 ± 4.50 mm | NA | Struvite + apatite (7.9%) Uric acid (3.2%) Whewellite (38.1%) Whewellite + apatite (30.2%) Weddellite (20.6%) | |
Aghamir | TB | 2.81 ± 0.59 cm2
| NA | NA |
SD | 2.87 ± 0.62 cm2
| NA | NA | |
Istanbulluoglu | TB | 448.93 ± 249.13 mm2
| lower calyx (26) pelvis (11) multiple calyces(6) upper ureter (1) upper calyx (1) | NA |
SD | 453.35 ± 165.97 mm2
| lower calyx (14) pelvis (19) multiple calyces (10) upper ureter (2) | NA | |
Crook | TB | 17.5 mm | NA | NA |
SD | 21.6 mm | NA | NA | |
Singh | TB | 750 mm2
| Superior (9) middle (12) inferior calices (9) | mixture of calcium oxalate monohydrate /calcium oxalate dihydrate stones (71%) calcium phosphate (7%) carbonate apatite (7%) magnesium ammonium phosphate hexahydrate (7%) pure calcium oxalate monohydrate (7%) xanthine (1%) |
SD | 800 mm2
| Superior (9) middle (15) inferior calices (7) | ||
Shah | TB | 535.36 ± 543.39 mm2
| NA | Calcium oxalate monohydrate (60.6%) Calcium oxalate dihydrate (18.18%) Calcium phosphate (3.03%) Struvite (12.12%) Uric acid (6.06%) Cystine (0%) |
SD | 495.91 ± 445.92 mm2
| NA | Calcium oxalate monohydrate (53.12%) Calcium oxalate dihydrate (28.12%) Calcium phosphate (0%) Struvite (9.37%) Uric acid (6.25%) Cystine (3.12%) | |
Agrawal, Madhu S | TB | 3.8 (1–5.7) cm2
| NA | calcium oxalate (87%) struvite (7%) uric acid (1%) |
SD | 3.6 (1.1–5.3) cm2
| NA | calcium oxalate (84%) struvite (9%) uric acid (3%) | |
Tefekli | TB | 3.0 ± 0.7 cm2
| Renal pelvis (6) Lower pole calyx (11) | NA |
SD | 3.1 ± 0.9 cm2
| Renal pelvis (9) Lower pole calyx (9) | NA | |
Choi | TB | 28.5 ± 15.4 mm | NA | NA |
SD | 26.8 ± 13.5 mm | NA | NA |
Quality assessment
Publication bias
Factors | No. of studies | P valuea
| 95% CI |
---|---|---|---|
Stone-free rate | 11 | 0.956 | [−0.711, 0 .675] |
Operative time | 9 | 0.385 | [−3.073, 1.344] |
Hospital stay | 11 | 0.874 | [−8.048, 9.303] |
Return to normal activity | 7 | 0.24 | [−17.820, 5.653] |
Postoperative hemoglobin drop | 10 | 0.694 | [−1.720, 1.202] |
Postoperative analgesia equivalents | 5 | 0.747 | [−9.673, 12.096] |
Postoperative pain scores | 10 | 0.011 | [1.664, 9.500] |
Blood transfusion | 7 | 0.545 | [−2.640, 4.426] |
Fever | 7 | 0.627 | [−1.311, 1.972] |
Urine leakage | 7 | 0.487 | [−4.716, 2.585] |
Influence analysis
Meta-analysis
Operative time
Hospital stay
Return to normal activity
Postoperative hemoglobin drop
Postoperative analgesia requirements
Postoperative pain scores
Stone-free rate
Blood transfusion
Fever
Urine leakage
Readmission
Sensitivity analysis
Items | No. ofstudies | Reference of studies | Sample size | Tests forheterogeneity | Analysis model | Test for overalleffect | RR/WMD/SMD | Favor | ||
---|---|---|---|---|---|---|---|---|---|---|
TB/SD | I2
| Pa
| Z | Pa
| 95% CI | |||||
Analysis of partial tubeless studies | ||||||||||
Stone-free rate | 7 | 234/234 | 0% | 0.830 | Fixed | 1.22 | 0.222 | 1.033[0.980,1.089] | TB | |
Operative time | 5 | 118/118 | 57% | 0.054 | Random | 1.20 | 0.229b
| −3.253[−8.547,2.041] | TB | |
Hospital stay | 7 | 316/316 | 99% | <0.0001 | Random | 4.52 | <0.0001 | −0.931[−1.335,-0.528] | TB | |
Return to normal activity | 4 | 226/226 | 0% | 0.528 | Fixed | 24.76 | <0.0001 | −3.346[−3.610,-3.081] | TB | |
Postoperative hemoglobin drop | 6 | 290/290 | 48% | 0.088 | Fixed | 1.43 | 0.152 | −0.026[−0.063,0.010] | TB | |
Postoperative analgesic requirements | 6 | 286/286 | 65% | 0.013 | Random | 7.33 | <0.0001 | −1.262[−1.600,-0.925] | TB | |
Postoperative pain scores | 5 | 259/258 | 94% | <0.0001 | Random | 8.28 | <0.0001 | −20.750[−25.661,-15.839] | TB | |
Blood transfusion | 4 | 90/89 | 0% | 0.761 | Fixed | 0.63 | 0.528 | 1.487[0.434,5.088] | SD | |
Fever | 5 | 250/248 | 0% | 0.920 | Fixed | 0.59 | 0.556 | 1.253[0.592,2.650] | SD | |
Urine leakage | 4 | 233/232 | 18% | 0.303 | Fixed | 2.45 | 0.014 | 0.213[0.062,0.736] | TB | |
Analysis of total tubeless studies | ||||||||||
Stone-free rate | 4 | 184/180 | 0% | 0.650 | Fixed | 0.58 | 0.565 | 0.976[0.900,1.059] | SD | |
Operative time | 4 | 204/200 | 55% | 0.082 | Random | 2.00 | 0.045 | −3.844[−7.609,-0.078] | TB | |
Hospital stay | 4 | 204/200 | 98% | <0.0001 | Random | 2.20 | 0.028 | −1.907[−3.606,-0.207] | TB | |
Return to normal activity | 3 | 159/155 | 99% | <0.0001 | Random | 1.70 | 0.090 | −5.855[−12.618,0.909] | TB | |
Postoperative hemoglobin drop | 4 | 204/200 | 44% | 0.147 | Fixed | 0.53 | 0.597 | −0.009[−0.043,0.025] | TB | |
Postoperative analgesic requirements | 3 | 159/155 | 97% | <0.0001 | Random | 1.86 | 0.062 | −1.502[−3.081,0.077] | TB | |
Postoperative pain scores | 2 | 124/120 | 95% | <0.0001 | Random | 3.01 | 0.003 | −17.448[−28.816,-6.081] | TB | |
Blood transfusion | 3 | 136/137 | 0% | 0.746 | Fixed | 1.29 | 0.198 | 0.503[0.176,1.432] | TB | |
Fever | 2 | 101/102 | 0% | 0.585 | Fixed | 0.55 | 0.583 | 0.745[0.260,2.133] | TB | |
Urine leakage | 3 | 169/165 | 68% | 0.046 | Fixed | 1.14 | 0.254c
| 0.351[0.058,2.122] | TB |
Items | No. ofstudies | Reference of studies | Sample size | Tests forheterogeneity | Analysis model | Test for overalleffect | RR/WMD/SMD | Favor | ||
---|---|---|---|---|---|---|---|---|---|---|
TB/SD | I2
| Pa
| Z | Pa
| 95% CI | |||||
Stone-free rate | 10 | 463/459 | 0% | 0.910 | Fixed | 0.32 | 0.747 | 0.992 [0.946,1.041] | SD | |
Operative time | 7 | 266/262 | 62.8% | 0.013 | Random | 1.98 | 0.048 | −3.436 [−6.837,-0.036] | TB | |
Hospital stay | 10 | 480/476 | 96.9% | <0.0001 | Random | 10.02 | <0.0001 | −1.435 [−1.716,-1.154] | TB | |
Return to normal activity | 7 | 385/381 | 97.5% | <0.0001 | Random | 5.44 | <0.0001 | −4.235 [−5.761,-2.709] | TB | |
Postoperative hemoglobin drop | 8 | 438/434 | 49.7% | 0.053 | Fixed | 1.37 | 0.169 | −0.018 [−0.043,0.008] | TB | |
Postoperative analgesic requirements | 8 | 405/401 | 91.4% | <0.0001 | Random | 4.79 | <0.0001 | −1.234 [−1.739,-0.729] | TB | |
Postoperative pain scores | 7 | 383/378 | 94.9% | <0.0001 | Random | 6.35 | <0.0001 | −15.787 [−20.660,-10.913] | TB | |
Blood transfusion | 7 | 226/226 | 0% | 0.768 | Fixed | 0.62 | 0.538 | 0.785 [0.364,1.696] | TB | |
Fever | 6 | 333/333 | 0% | 0.906 | Fixed | <0.001 | 0.999 | 1.001 [0.521,1.922] | SD | |
Urine leakage | 6 | 386/381 | 40.4% | 0.136 | Fixed | 3.64 | <0.0001 | 0.259[0.125,0.537] | TB |