All eligible studies were searched on MEDLINE, Embase, and the Cochrane Library databases. Risk ratio (RR), mean difference, or standardized mean difference (SMD), with its 95 % CI, was used to evaluate the size effect.
Ten and 3 trials were identified for comparison I (tubeless PCNL vs standard PCNL, 320 cases and 323 controls) and comparison II (tubeless PCNL vs small-bore PCNL, 55 cases and 54 controls), respectively. Tubeless PCNL required significantly less analgesia relative to standard PCNL (SMD ?.72; 95 % CI ?.30 to 1.13; Pheterogeneity = 0.04) and small-pore PCNL (SMD ?.69; 95 % CI ?.13 to 2.05; Pheterogeneity = 0.94). Furthermore, there was a remarkably shorter hospital stay in comparison I (SMD ?.35; 95 % CI ?.40 to 1.30; Pheterogeneity = 0.60) and comparison II (SMD ?.49; 95 % CI ?.76 to 0.21; Pheterogeneity = 0.15). The return to normal activity days was also significantly decreased in comparison I (SMD ?.34; 95 % CI ?.28 to 2.41; Pheterogeneity = 0.02). However, no significant difference was observed in the analyses concerning stone-free blood transfusion and complications rate in both comparisons. In subgroup analyses by nephrostomy diameter (22-Fr) and drainage methods, most results were consistent with the overall findings except for that to evaluate the operative time in the double-J stent subgroup.
Tubeless PCNL is associated with less pain and quicker recovery compared with standard or small-bore PCNL, in the management of uncomplicated renal calculi.