title: Standard versus tubeless percutaneous nephrolithotomy: a systematic review.
abstract: OBJECTIVE
  This article systematically analyses comparative studies to evaluate the efficacy and safety of tubeless percutaneous nephrolithotomy (PCNL) versus standard PCNL.
  
  
  METHODS
  The Medline, EMBASE, PsycINFO, Cochrane and DARE databases were searched from 1997 to February 2011. Comparative studies evaluating outcomes from standard versus tubeless PCNL were included. Primary outcome measures were post-operative pain scoring, analgesic requirements, duration of hospitalisation/convalescence, operation time, major/minor complications and stone-free rates.
  
  
  RESULTS
  Twenty-four studies were included (11 randomised control trials and 13 retrospective or prospective studies). Levels of pain recorded, analgesic requirements, duration of inpatient stay and convalescence time were all significantly reduced in the tubeless PCNL group. Cost was reduced in two studies. Morbidity was not significantly different between the groups. There was no significant difference between groups regarding stone-free status.
  
  
  CONCLUSIONS
  This systematic review has demonstrated that tubeless PCNL is a viable alternative to tubed PCNL in uncomplicated cases. Benefits are as described above. There is no evidence suggesting that patient safety is compromised by the absence of post-operative nephrostomy. The tubeless method has been reported in challenging cases such as stag-horn stones, horseshoe or ectopic kidneys. Promising outcomes have been demonstrated in elderly patients and when clinical needs demand a supracostal approach. Multi-centre randomised controlled trials are needed to fully establish the effectiveness of the tubeless method.
authors.affiliation: Department of Urology, Guy's Hospital, MRC Centre for Transplantation, King's College London, King's Health Partners, London, UK.
authors.forename: Tarik
authors.initials: T
authors.lastname: Amer
authors.forename: Kamran
authors.initials: K
authors.lastname: Ahmed
authors.forename: Matthew
authors.initials: M
authors.lastname: Bultitude
authors.forename: Shahid
authors.initials: S
authors.lastname: Khan
authors.forename: Pardeep
authors.initials: P
authors.lastname: Kumar
authors.forename: Antonella
authors.initials: A
authors.lastname: De Rosa
authors.forename: Mohammed Shamim
authors.initials: MS
authors.lastname: Khan
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hegarty
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D017721:Hospital Costs; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D007902:Length of Stay; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D020127:Recovery of Function; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics