Safety and efficacy of standard vs. tubeless percutaneous nephrolithotomy in pediatric populations: an updated systematic review and meta-analysis.

Abstract

<h4>Objective</h4>This study aims to compare the safety and efficacy of standard versus tubeless percutaneous nephrolithotomy (PCNL) in pediatric populations.<h4>Methods</h4>A systematic search was conducted in the Web of Science, Cochrane Library, PubMed, and Embase databases to identify studies that met the inclusion criteria. Two authors independently screened the literature and extracted data. A meta-analysis was performed using RevMan 5.4 software. This study has been prospectively registered with PROSPERO (ID: CRD42024622238). Sensitivity analysis was performed using Stata 17.0 to assess the impact of low-quality studies, and publication bias was evaluated using funnel plots.<h4>Results</h4>A total of 3 randomized controlled trials and 10 case-control studies were included, comprising 661 cases. The meta-analysis revealed that, in pediatric populations, the tubeless PCNL group had significantly shorter hospital stays compared to the standard PCNL group (WMD = -1.60, 95% CI: -2.27 to -0.92, P < 0.01), as well as shorter operative times (WMD = -2.06, 95% CI: -4.02 to -0.10, P = 0.04). The stone clearance rate was higher in the tubeless PCNL group than in the standard group (OR = 2.18, 95% CI: 1.09 to 4.34, P = 0.03). Additionally, the tubeless PCNL group had lower rates of postoperative fever (OR = 0.46, 95% CI: 0.27 to 0.78, P < 0.01) and postoperative urine leakage (OR = 0.20, 95% CI: 0.08 to 0.50, P < 0.01) compared to the standard group. The tubeless PCNL group also had shorter pain management times (WMD = -2.00, 95% CI: -2.44 to -1.56, P < 0.01) and lower visual analog scale (VAS) scores (WMD = -2.52, 95% CI: -2.81 to -2.22, P < 0.01). However, no significant differences were observed between the two groups in terms of hemoglobin decline, overall complications (including perinephric fluid collections, urinary tract infections, and blood transfusion requirements), and reoperation rates.<h4>Conclusion</h4>In children with kidney stones and low stone burden or an uneventful procedure, tubeless PCNL offers clear clinical advantages, including shorter hospital stays, higher stone clearance rates, and lower postoperative fever. Additionally, it improves surgical efficiency, reduces postoperative complications, and decreases the need for analgesia. These benefits suggest that tubeless PCNL can be safely applied in pediatric patients, yielding outcomes comparable to standard PCNL, provided that indications are properly managed".<h4>Clinical trial number</h4>Not applicable.