Tubeless PCNL Research Articles

Ambulatory, tubeless PCNL is a viable option in 10-25 mm stones.

Ambulatory, tubeless PCNL is a viable option in 10-25 mm stones.

Is Totally Tubeless Percutaneous Nephrolithotomy a Safe and Efficacious Option for Complex Stone Disease?

Background: Percutaneous nephrolithotomy is the gold standard treatment for large, complex intrarenal stones. Historically, this was performed using a nephrostomy tube (PCN) and/or internalized ureteral stent at the end of the procedure. However, totally tubeless nephrolithotomy (tt-PCNL) is a novel technique where no tubes (no stent nor nephrostomy tube) are left post-operatively. We review the literature on this subject regarding peri-operative outcomes, post-operative outcomes, and potential complications of the procedure, discuss our technique, and make recommendations on implementation for centers not currently utilizing the procedure. Materials and methods: We performed a comprehensive search of the literature on totally tubeless nephrolithotomy using MEDLINE database search. Our search included prior review articles, meta-analyses, systematic reviews, primary research articles, case reports, and case studies. Results: In comparison to prior approaches where a stent or nephrostomy tube is placed, tt-PCNL has a similar complication rate and better post-operative outcomes. Totally tubeless PCNL has similar operative times and similar changes in hemoglobin. However, it had shorter length of stays across all studies. The mean difference in length of stay in the studies reviewed was 1.96 days. Additionally, tt-PCNL had decreased post-operative analgesic requirements and pain scores. Conclusions: This review highlights totally tubeless percutaneous nephrolithotomy as a safe and feasible surgical technique with improved outcomes in properly selected patients.

MP23-01 A RANDOMISED CONTROLLED STUDY COMPARING STANDARD TUBELESS PCNL & TUBELESS MINI-PCNL FOR RENAL STONES LESS THAN 2 CM

You have accessJournal of UrologyCME1 Apr 2023MP23-01 A RANDOMISED CONTROLLED STUDY COMPARING STANDARD TUBELESS PCNL & TUBELESS MINI-PCNL FOR RENAL STONES LESS THAN 2 CM Aditya Yelikar Aditya YelikarAditya Yelikar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PCNL has become a standard minimally invasive treatment for renal stones. Tubeless PCNL is associated with less morbidity. Miniaturisation of instruments leads decrease morbidity of procedure. We compared standard tubeless PCNL to Miniperc tubeless PCNL for morbidity and stone free rates in order to improve outcomes of PCNL with minimal morbidity. METHODS: Our study included 100 patients, 50 patients in group 1 (standard tubeless PCNL) & 50 patients in group 2 (tubeless mini PCNL) , with single renal stone less than 2 cm. Patients with CKD, solitary kidney, ectopic kidney and previous diversion were excluded. Tract was dilated upto 24 Fr in group 1 & upto 16 Fr in group 2. No percutaneous nephrostomy was kept. Post operative pain score was monitored at 12 and 24 hours. Additional analgesia was given if needed. Hemoglobin was measured pre operatively & on post op day 1. Stone clearance was checked with ultrasonography & XRay KUB (kidney-ureter-bladder). Total Operative time , pain score, analgesic requirement, haemoglobin drop, complications (bleeding, fever, urinary leak, urosepsis, hydro or pneumothorax) and stone free rate were compared. RESULTS: Miniperc operative time was longer than standard PCNL (45±10 vs 35±8 mins. p<0.001). Median pain score at 12 and 24 hours was more in group 1 than in group 2 (6±1 VS 4±1, p<0.0001 and 3±1 vs 2±1, p<0.001). Post operative hemoglobin drop was more in group 1 than in group 2 (0.95±0.2 VS 0.6±0.1, p<0.0001). Stone clearance in group 1 was 100% while in group 2 it was 95%. There was no significant difference in complications between the two groups. CONCLUSIONS: Both Standard tubeless PCNL & tubeless Mini PCNL are effective for renal stones less than 2 cm. Operative time is more in tubeless Mini PCNL whereas pain score, analgesics requirement and hemoglobin drop are more in standard tubeless PCNL comparatively. Stone clearance in both groups is comparable and more than 95%. Source of Funding: Nil © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e306 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aditya Yelikar More articles by this author Expand All Advertisement PDF downloadLoading ...

Standard Versus Tubeless Percutaneous Nephrolithotomy in Children: A Comparative Study at Tertiary Care Centre

Background: Percutaneous nephrolithotomy is a urological technique advocated to extract kidney and proximal ureter calculi. Various strategies evolved throughout time as a result of experiences and new instruments. Tubeless PCNL is chosen over traditional PCNL due to fewer post-operative problems, a shorter patient hospital stay, and shorter procedure duration. This is the first of its kind study, to our knowledge in paediatric population in our setup. Objective: To compare the outcomes of standard versus tubeless percutaneous nephrolithotomy in children. Material and Methods: This prospective descriptive comparative study conducted at Department of Paediatric Urology, Institute of Kidney Disease, Peshawar; from October 2021 to September 2022 consisting of 100 patients. Patients in the age range of 4 to 14 years with renal or ureteric stones were arbitrarily assigned to two groups. Group A underwent through standard PCNL and group B underwent through tubeless PCNL. Outcomes of both groups were compared in terms of operative time, post-op pain and post-op complications. All the data was analyzed through SPSS version 24. Results: Mean age of the patients in group A and B was 9.12±2.07 years and 8.68±1.82 years respectively. The mean operation time, hospital stay in group A (standard PCNL) and B (tubeless PCNL) were 86.06 ±7.20 minutes, 6.46±.97 days and 83.68 ±3.81 minutes and 3.42±.81days respectively. The mean VAS pain scores in group A and group B were 6.24 ± .71 and 3.70 ± .81 respectively. Post operative complications were less seen in the tubeless PCNL. Conclusions: Tubeless PCNL is a safe technique having shorter operative time while post-operatively associated with shorter hospital stay and fewer complications as compared to standard PCNL. Keywords: Renal Stones, Standard PCNL, Tubeless PCNL, Outcomes Abbreviations: PCNL=Percutaneous Nephrolithotomy, VAS=Visual Analogue Scale

Comparison of Efficacy and Outcome of Tubeless with Standard Percutaneous Nephrolithotomy in Patient with Renal Stones

Objective: To compare the outcome and complications of standard PCNL with tubeless PCNL in terms of analgesia requirement, incidence of infection, post-operative perinephric urinary collection and post-operative hospital stay. Study Design: Randomized control trial Place and Duration of Study: Department of Urology, Lahore General Hospital Lahore from 1st March 2018 to 30th April 2019. Methodology: Ninety six patients fulfilling the inclusion criteria were randomly categorized into 2 groups; Group A where patients will undergo standard PCNL and Group B where patients will undergo tubeless PCNL. Post-operatively, patients were assessed for the requirement for analgesia, rate of infection, post-operative urinary leakage and hospital stay. Results: The mean duration of surgery had no significant difference between the two treatment groups; tubeless group was on average 51 minutes while the standard PCNL group was 55 minutes. No significant difference was observed in reduction of hematocrit values between the groups (4.9% vs 4.2%). Transfusions were not required in either group. The average post-operative duration of hospital stay was 2 days in group 1 and group 2 was 3 days with P&lt;0.001. Conclusion: Tubeless PCNL is effective in patients with kidney stones and requires fewer analgesic drugs and shorter hospital stay, post-operative complications are almost the same in both groups with no significant difference. Key words: PCNL, Standard, Tubeless, Complications

Single institutional study on tubeless percutaneous nephrolithotomy

Background: The occurrence of renal stone is increasing which affect 10% of population with recurrence being 70% in affected patients. Tubeless PCNL is the mainstay of treatment in the management of large and complex stones. This study was conducted to evaluate the efficacy, feasibility and safety of tubeless PCNL.Methods: This study was conducted in the department of general surgery, Jagjivan Ram Railway Hospital, Mumbai over a period of one year from March 2019-Febuarary 2020. During this period 50 patients underwent tubeless PCNL for renal stones.Results: Among 50 patients 56% were in the age group of 46-60 years. Most common presenting complaint being flank pain (94%). About 86% of patient had complete stone clearance following tubeless PCNL. Post operative blood transfusion required in 10% of patients. The mean hospital stay was 2.12 days. Most common post operative complication were fever.Conclusions: Tubeless PCNL is a very safe and effective treatment for renal stones.

Standard versus Tubeless Percutaneous Nephrolithotomy in Tertiary Care Centre: A Randomized Control Trial

Nephrolithiasis is a common health problem usually presenting as acute complication. Objective: This study was aimed to know the comparative outcomes of the standard tube PCNL and tubeless PCNL in our population. Methods: It was a prospective randomized controlled study conducted in Lady Reading Hospital Peshawar; Urology Department consisting of 100 patients randomly selected who underwent percutanatous nephrolithotomy dividing into two groups; group 1 underwent through standard PCNL and group 2 underwent through tubeless PCNL. All the data were analyzed through SPSS version 20. Means and standard deviations of the quantitative variables and frequencies and percentages of the qualitative variables were determined. Results: There was no significant difference in the demographics of both the groups. The mean operation time, hospital stay in group 1 (standard PCNL) were 86.06 ± 7.20 and 6.46 ± 0.97 respectively while the mean of operation time, hospital stay in group2 (tubeless PCNL) were 83.68 ± 3.81 and 3.42 ± 0.81, respectively. The mean of visual analogue scale scores for pain in group 1 and group 2 were 6.24 ± 0.71 and 3.70 ± 0.81, respectively. There as significant difference in the VAS score of both groups. Post operative complications were less seen in the tubeless PCNL. Conclusions: The tubeless PCNL is a safe technique having short operation time and statistically significant short hospital stay and low Visual Analogue Scale score for pain post operatively. Tubeless PCNL is associated with less post operative complications as compared to the standard PCNL.

The Modified Procedure of Totally Tubeless PNL

Mini percutaneous nephrolithotomy (mPNL) is a standard treatment for kidney stones larger than 1.5 cm, with the placement of a nephrostomy drainage at the end of it, which is considered the standard procedure, but tubeless/ totally tubeless mPNL techniques reduce postoperative discomfort in patients and shorten hospital stays. The aim of article was to compare the efficacy and safety of our proposed modified method of totally tubeless mPNL with control of the parenchymal canal, with existing methods of tubeless/totally tubeless mPNL. Novelty of the study presented by modified method of totally tubeless mPNL. During the period from 2018 to 2020 we performed 486 mPNL were performed in our clinic in total, among which 63 (12.9%) patients underwent tubeless PNL. Patients whose surgeries ended with using tubeless techniques were divided into three groups: Group I – 22 patients who had tubeless mPNL (with ureteral stent), Group II (20 patients) – totally tubeless mPNL with a safety thread (the proposed procedure), Group III (21 patients) – totally tubeless mPNL. In all three groups, the access point was most often made through the lower group of renal calyces: Group I – 12 (54.5%), Group II – 14 (70.0%), Group III – 13 (61.9%); then through the middle calyx: Group I – 8 (36.4%), Group II – 6 (30.0%), Group III – 7 (33.3%); and the upper calyx: Group І – 2 (9.1%), Group ІІ – 0%, Group ІІІ – 1 (4.8%), no differences in the distribution of access points between groups were found (p=0.67). There were no differences in the distribution of tract sizes between the groups (p=0.95) with tract dilatation to 16.5/17.5 Fr was performed most often: Group I – 12 (54.5%), in Group II – 11 (55.0%) and Group III – 11 (52.4%). The mean duration of surgery in Group I was 83.0±22.9 min, in Group II – 74.9±13.6 min, in Group III – 72.6±12.0 min (p=0.47). This study confirms the high effectiveness of totally tubeless mPNL. The proposed modification to perform totally tubeless mPNL allows you to have permanent postoperative control over the parenchymal channel and in case of postoperative bleeding it enables you to immediately insert nephrostomy drainage through the safety thread. Study contributes to practical methods as an intermediate step for surgeons who are considering transition to a totally tubeless PCNL technique.

Safety and Efficacy of Day Case Tubeless Percutaneous Nephrolithotomy

Abstract Objective to determine the outcome of day cases tubeless PCNL with only 12 hours hospital stay regarding vital data, postoperative bleeding and pain. Materials and Methods We prospectively reviewed 50 patients presenting to our university hospital with renal pelvic radioopaque stones less than 2 cm underwent tubeless PCNL discharged within 12 hours postoperatively. Operation time ,Occurrence of intraoperative complications and Post operative vital data , hemoglobin level were recorded Results All 50 patient ,16 female ,34 male patient underwent totally tubeless PCNL , intraoperatively , the operation time ranging from 45 to 85 minutes . postoperatively , the study revealed that 3 patients were found hypotensive( 6%), fever more than 38 degree occurred in 7 patients (14%) . Hemoglobin level dropped more than 1gm/dl in only 4 patients 8% , blood transfusion needed in only 2 patients , hospital readmission was needed by 7 patients (14%) within 1 week postoperatively. Outpatient follow up of the patients underwent daycase PCNL revealed that 39 patient returned to normal activities within 4 days (78%) but 11 patients took 4-7 days( 12%) Conclusions Tubeless PCNL is safe, feasible, and less morbid alternative to classic PCNL . decreased period of hospital stay , rapid return to normal social activities decreasing the economic burden regarding person and society.

Tubeless Percutaneous Nephrolithotomy with Hemostatic Plug Using Surgiflo® versus Standard Percutaneous Nephrolithotomy using a Nephrostomy Tube: A Prospective Randomized Controlled Study

Abstract Background Percutaneous Nephrolithotomy (PCNL) is the preferred technique for treating large renal stones (over 2cm in diameter). It involves keyhole surgery performed through a small skin incision overlying the kidney. Objectives Our study aimed at evaluating the safety and efficacy of local hemostatic sealant (surgiflo®) use in tubeless PCNL to enhance postoperative outcomes of PCNL. Patients and Methods We randomized our patients into two groups, Group A nephrostomy tube was used as standard PCNL, and at group B tubeless PCNL was done followed by injection of the local hemostatic flowable gelatin matrix (surgiflo®) under fluoroscopic guidance in the prone position Results There was no statistically significant difference between two groups regarding demographic data age, sex and BMI (P- value 0.280, 0.736 and 0.440 respectively), stone site and size (P- value 0.525 and 0.533 respectively), operative time (P- value 0.855), intraoperative complications as blood loss and pelvicalyceal perforation, (P- value 0.92 and P- value 0.83 respectively), postoperative complication as fever, haematuria and UTI (P- value 1.000, 0,113 and 1.000 respectivly), and Hb drop (P- value 0.735). Conclusion Tubeless PCNL with hemostatic sealant use is associated with less pain, no leakage from nephrostomy tract, less narcotic agent use, and a shorter hospital stay.

Supine tubeless PCNL in horseshoe kidney (a series of cases).

Objective of this case series is accurate access to the respective calyx with stone in horseshoe kidney while performing percutaneous nephrolithotmy in supine position. Reducing operative time and anaesthetic morbidity while performing percutaneous nephrolithotomy in horseshoe kidney with nephrolithiasis in supine position. Four patient with one having bilateral renal calculi with horshoe kidney were selected randomly. There were no preference for age, gender; size, location and laterality of stone or BMI. All the patients fit into the AUA guideline criteria for management by percutaneous nephrolithotomy. Preoperative, perioperative and follow up data were collected. Four patients with one having bilateral renal calculi underwent supine tubeless PCNL in 1 year in GMSV position. There was no intraoperative, post operative or on follow up complications in any patient. In all the patients stones were cleared completely in single setting. Supine percutaneous nephrolithotomy in horseshoe kidney is an alternative to the standard prone percutaneous nephrolithotomy in the horseshoe kidney. It provides an additional benefit of performing the procedure in a single position, which is known to reduce total operating time, less anaesthesia related complications and less neuromusculoskeletal injury.

Percutaneous Nephrolithotomy: A Comparison of Tubeless versus the Standard technique

Objective: The proposed study aimed to assess the utility of tubeless PCNL in terms of efficacy and safety when compared with the standard tubed PCNL.&#x0D; Materials &amp; Methods: In this study 280 patients (age ranged 08-70 years) who underwent PCNL were included.&#x0D; Results: The patients were from both genders i.e., 156 males and 124 females. Out of 280 patients, 140 had a 16 FR nephrostomy tube (Group A) whiles an equal number had 4.8F DJ Stent (Group B) for postoperative drainage. A comparison of the postoperative outcome among the two groups was made for a period of two years (November 2017 to October 2019). Neither any significant difference was found in the mean stone size, operative time, nor was stone-free status, nor any major complication observed. The mean hospital stay for group A and group B was 4.5 days (range 3 to 6) and 3.2 days (range 2 to 4) respectively. An early postoperative wound soakage was found in 18 (12.8%) cases of group A in contrast to the group B patients in whom only 2 (1.4%) had soakage.&#x0D; Conclusion: It was concluded that Tubeless PCNL as compared to the standard tubed PCNL was found more efficacious and safer and it should be adopted as a routine procedure.

English

English

UP010 - Tubeless PCNL - What is the evidence?

UP010 - Tubeless PCNL - What is the evidence?

Tubeless PCNL – Contemporary Analysis of Indications, Safety and Efficacy

Tubeless PCNL – Contemporary Analysis of Indications, Safety and Efficacy

Tubeless percutaneous nephrolithotomy, are there any real benefits?

Aims & objectives: To assess the benefits of Tubeless PCNL [T PCNL] with regard to cost, tolerability over conventional PCNL [C PCNL]. Materials and Methods: This prospective study included patients undergoing Percutaneus nephrolithotomy during a period between 2007 to 2017. The selection criteria for placing the patient in tubeless arm were - Maximum stone burden of 3 cm; Single access tract; Minimal or negligible hemorrhage during the procedure; Operative time of less than two hours; lack of collecting system perforations; clinically insignificant residual fragments. In those who met the criteria antegrade stenting was done without a nephrostomy. In those patients, who did not full fill the inclusion criteria, a 24 F Nephrostomy tube was placed at the end of procedure. Results: The study cohort included 373 patients consisting of 211 males and 162 females in 3rd to 5th decades of their lives. Those under T PCNL and C PCNL arms were 301 and 72 respectively. The stone size varied from 17-27 mm with a mean of 22 mm. The procedure time varied between 35 to 97 minutes with a mean of 66 minutes. The T PCNL arm was analyzed with regard to Analgesic requirement; Duration of hospital stay and the total cost of the treatment and compared with those under C PCNL. Patients under had their catheter removed on 2nd postoperative day and discharged on the same day afternoon if the operative site did not develop any leak. For those under C PCNL, Nephrostomy was clamped at 48hrs if the drainage was clear and X KUB did not show any significant residual fragments. Re look procedure was planned if there bigger residual fragments. The pain was assessed using visual analogue scale (VAS) at 6, 12 & 24 hrs. Post procedure and analgesia was administered as per requirement. Majority of patients (90.7%), under T PCNL rated their pain perception highest (4-6) at 6 hrs., which came down to 2-4 at 12 hrs. They did not need any analgesia at 24 hrs., rating their pain at 1-2. mean of 3.9. The same under C PCNL was higher at 8-9 on VAS at 6 hrs, 6-8 at 12 hrs and 4-6 at 24 hrs. Parenteral Diclofenac the drug of choice for pain relief and the mean analgesic requirement was 75 mg of Diclofenac. The Analgesic requirement was higher under C PCNL arm. None required blood transfusion as the fall in hematocrit was negligible under T PCNL. The mean hospital stay in those who underwent T PCNL was 3 days as compared to 5 days under C PCNL. Conclusion: Tubeless PCNL offers a significant benefit in terms of lesser analgesic requirement, shorter hospital stay but necessitates an additional procedure with cost in stent removal. By using stents with setons might obviate stent removal and hence the cost.

A non-inferiority study to analyze the safety of totally tubeless percutaneous nephrolithotomy

Totally tubeless percutaneous nephrolithotomy (ttPCNL) becomes increasingly frequently utilized in the treatment of kidney stones. This procedure emerged as an answer for patients' needs to minimize hospitalization time, pain intensity and discomfort due to nephrostomy tube. However, ttPCNL may be less safe for patients, as without nephrostomy tube bleeding from renal vessels is potentially more severe. The purpose of our study was to retrospectively evaluate the safety parameters of ttPCNL collected in a prospective manner. This was a single tertiary care center, non-inferiority study with 2 arms (55 patients in each arm). The 1st group consisted of patients who underwent ttPCNL with the application of TachoSil® (Takeda, Osaka, Japan) as sealing material, while in the 2nd group, conventional PCNL with nephrostomy tube (cPCNL) was utilized. The primary goal was to prove that hemoglobin drop after surgery, as equivalent of safety, was not inferior than 1 g/dL. The secondary endpoints comprised visual analogue scale (VAS) of pain, additional pain treatment and hospital stay. The mean hemoglobin drop after ttPCNL was insignificantly lower in comparison with cPCNL group (mean: -0.35 g/dL; confidence interval (CI) = -0.8, 0.21). Visual analogue scale of pain and pain treatment were comparable between groups. Hospital stay was significantly shorter in the ttPCNL group. Totally tubeless PCNL can be considered a safe option after uncomplicated lithotripsy - what is important, it is characterized by a shorter hospitalization time. Postoperatively, pain intensity is comparable between both groups.

Comparison of Standard and Tubeless Percutaneous Nephrolithotomy in a Tertiary Care Hospital in Eastern Nepal

Introduction PCNL is a minimally invasive technique for treatment of renal and upper ureteral stones and has gone modifications like tubeless, total tubeless, mini and ultra mini PCNL.Objective To compare efficacy, safety and outcome of tubeless PCNL with standard PCNL.Methodology The study was conducted from January 2017 to December 2017 involving 50 patients undergoing PCNL randomized into standard PCNL group (S group) and tubeless PCNL group (T group) each arm containing 25 patients. Patients with congenital renal anomalies, solitary functioning kidney, previous renal surgery, clinically significant residual stones/fragments, perforation of pelvi-calyceal system and requiring conversion were excluded. Data analyzed using SPSS 20, chi-square test and Student's t test was used where appropriate. A p-value of &lt;0.05 was considered significant.Results Mean age, mean stone size, preoperative hemoglobin level and creatinine level in group S and T were comparable. Similarly postoperative hemoglobin level and creatinine level in groups S and T were comparable. The mean operating time in group S was 99.38± 16.24min and 89.38 ± 12.27min in group T ( p=0.02). Postoperatively, VAS in group S was 5.25± 0.94 and 2.88± 1.68 in group T ( p&lt;0.001). Complication occurred in 9 patients in S group as postoperative anemia (hemoglobin &lt;10gram/dl)-3 cases, superficial surgical site infecon-4 and urine leak-2 while it was seen in 3 patients in T group as stoma site hematoma-2 and anemia-1 (p= 0.04). Three patients in group S and 1 patient in group T respectively required transfusion (p= 0.82). Postoperative analgesic requirement in S and T groups were 13.08± 2.39 and 9.03± 2.44 grams of paracetamol respectively ( p&lt;0.001). The hospital stay was 3.79± 0.58 days in S group and 2.54 ± 0.50 days in T group (p&lt;0.001).Conclusion Tubeless PCNL is a safe option in selected cases. It is associated with significantly less postoperative pain, analgesic requirement, postoperative complication and shorter duration of hospital stay minimizing treatment cost.BJHS 2018;3(1)5 : 366 - 369

866 - A comparison of tubeless versus totally tubeless PCNL

866 - A comparison of tubeless versus totally tubeless PCNL

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

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.