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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

Authors
 Joo Yong Lee  ;  Seong Uk Jeh  ;  Man Deuk Kim  ;  Dong Hyuk Kang  ;  Jong Kyou Kwon  ;  Won Sik Ham  ;  Young Deuk Choi  ;  Kang Su Cho 
Citation
 BMC Urology, Vol.17(1) : 48, 2017 
Journal Title
 BMC Urology 
Issue Date
2017
MeSH
Feasibility Studies ; Humans ; Intraoperative Care/instrumentation ; Intraoperative Care/methods* ; Kidney Calculi/diagnosis ; Kidney Calculi/surgery ; Length of Stay/trends ; Nephrolithotomy, Percutaneous/instrumentation ; Nephrolithotomy, Percutaneous/methods* ; Network Meta-Analysis ; Postoperative Care/instrumentation ; Postoperative Care/methods* ; Randomized Controlled Trials as Topic/methods* ; Retrospective Studies ; Treatment Outcome
Keywords
Bayes theorem ; Calculi ; Lithotripsy ; Meta-analysis ; Nephrostomy ; Percutaneous
Abstract
BACKGROUND: Percutaneous 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. METHODS: PubMed, 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. RESULTS: Sixteen 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. CONCLUSIONS: For 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.
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DOI
10.1186/s12894-017-0239-x
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
김만득(Kim, Man Deuk) ORCID logo https://orcid.org/0000-0002-3575-5847
이주용(Lee, Joo Yong) ORCID logo https://orcid.org/0000-0002-3470-1767
조강수(Cho, Kang Su) ORCID logo https://orcid.org/0000-0002-3500-8833
최영득(Choi, Young Deuk) ORCID logo https://orcid.org/0000-0002-8545-5797
함원식(Ham, Won Sik) ORCID logo https://orcid.org/0000-0003-2246-8838
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160263
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