Totally tubeless percutaneous nephrolithotomy versus standard percutaneous nephrolithotomy in the treatment of renal stones: An updated systematic review and meta-analysis

BACKGROUND: Percutaneous nephrolithotomy (PCNL) is a standard surgical procedure for kidney stone removal. Totally tubeless PCNL is a variation in technique in which neither an indwelling ureteric stent nor a nephrostomy tube is placed postoperatively. This meta-analysis compares the efficacy and safety of totally tubeless PCNL with standard PCNL. METHODS: PubMed, Scopus, Cochrane Library, and clinicaltrials.gov databases were searched until January 2025. The primary outcomes were stone-free rate, operative time and hospital stay while secondary outcomes were hemoglobin (Hb) drop, total complication rates and blood transfusion. Effect sizes were calculated using fixed and random-effects models, expressed as mean difference (MD) or risk ratio (RR) with 95% confidence intervals (CIs). RESULTS: = 0.30). Meta-regression suggested that stone size was not a significant predictor of procedural success or duration. CONCLUSION: Compared to standard PCNL, totally tubeless PCNL shortens operation time and hospital stay and lowers complication rates, with equivalent stone-free efficacy. These findings support its use as a preferred technique for appropriately selected patients.