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

BMC Urology

Research Article

Man Deuk Kim¹  Kang Su Cho²  Seong Uk Jeh³  Dong Hyuk Kang⁴  Jong Kyou Kwon⁵  Won Sik Ham⁶  Joo Yong Lee⁶  Young Deuk Choi⁶ 

[1] Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea;Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, 06273, Seoul, South Korea;Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, South Korea;Department of Urology, Inha University School of Medicine, Incheon, South Korea;Department of Urology, Severance Check-Up, Yonsei University Health System, Seoul, South Korea;Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea;

关键词: Calculi;    Lithotripsy;    Nephrostomy;    Percutaneous;    Meta-analysis;    Bayes theorem;   

DOI  :  10.1186/s12894-017-0239-x

 received in 2015-10-04, accepted in 2017-06-21,  发布年份 2017

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© The Author(s). 2017