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Meta-Analysis
. 2023 Jul 28;7(7):CD012607.
doi: 10.1002/14651858.CD012607.pub2.

Totally tubeless, tubeless, and tubed percutaneous nephrolithotomy for treating kidney stones

Konrad Wilhelm  1   2 , Simon Hein  1 , Frank Kunath  2   3 , Martin Schoenthaler  1 , Stefanie Schmidt  2
Affiliations
Meta-Analysis

Totally tubeless, tubeless, and tubed percutaneous nephrolithotomy for treating kidney stones

Konrad Wilhelm et al. Cochrane Database Syst Rev. .

Abstract

Background: Percutaneous nephrolithotomy (PNL) is the standard of care for removing large kidney stones (> 2 cm). Once the procedure is complete, different exiting strategies exist to manage the percutaneous tract opening, including placement of an external nephrostomy tube, placement of an internal ureteral stent, or no external or internal tube. The decision to place or not place a tube is handled differently among clinicians and may affect patient outcomes.

Objectives: To assess the effects of tubeless PNL (with ureteral stenting), totally tubeless PNL (without ureteral stenting or nephrostomy), and standard PNL (nephrostomy only) for the treatment of kidney stones in adults.

Search methods: We performed a systematic literature search in multiple biomedical databases (CENTRAL, MEDLINE, Embase, Web of Science), as well as in two clinical trial registries. We also handsearched reference lists of relevant publications and conference proceedings. We applied no language restrictions. The latest search update was conducted in September 2022.

Selection criteria: We included randomized controlled and quasi-randomized controlled trials of adult patients who received tubeless, totally tubeless, or standard PNL for treating kidney stones. We defined tubeless PNL as no nephrostomy tube, but ureteral stenting, while totally tubeless PNL meant no nephrostomy tube or ureteral stenting. Both interventions were compared to standard PNL with placement of a nephrostomy tube (only). We considered access tubes of any sizes. We only considered unilateral PNL with single-tract access. There were no exclusions on stone composition, size, or location.

Data collection and analysis: Two review authors independently screened the literature, extracted data, assessed risk of bias, and rated the certainty of evidence using GRADE. Primary outcomes were severe adverse events and postoperative pain, and secondary outcomes were operating time, length of hospital stay, and stone-free rate. We used the random-effects model for meta-analysis.

Main results: We included 10 studies in the review. Participant age varied among studies, ranging from 20 to 60 years. Detailed information on stone characteristics was rarely presented. Tubeless PNL versus standard PNL We are very uncertain whether there is a difference in severe adverse events (SAEs) between tubeless PNL and standard PNL (risk ratio (RR) 1.53, 95% confidence interval (CI) 0.14 to 16.46; I2 = 42%; 2 studies, 46 participants; very low-certainty evidence). Tubeless PNL may have little to no effect on pain on postoperative day one (mean difference (MD) 0.56 lower, 95% CI 1.34 lower to 0.21 higher; I2 = 84%; 4 studies, 186 participants; low-certainty evidence), and probably results in little to no difference in operating room time (MD 0.40 longer (in minutes), 95% CI 4.82 shorter to 5.62 longer; I2 = 0%; 3 studies, 81 participants; moderate-certainty evidence). Tubeless PNL may reduce length of hospital stay (MD 0.90 shorter, 95% CI 1.45 shorter to 0.35 shorter; I2 = 84%; 6 studies, 238 participants; low-certainty evidence). We are very uncertain of the effect of tubeless PNL on blood transfusions (RR 0.64, 95% CI 0.16 to 2.52; I2 = 0%; 4 studies, 161 participants; very low-certainty evidence), sepsis or fever (RR 0.50, 95% CI 0.05 to 4.75; I2 = not applicable; 2 studies, 82 participants; very low-certainty evidence), or readmissions (RR 1.00, 95% CI 0.07 to 14.21; I2 = not applicable, 1 study, 24 participants; very low-certainty evidence). Totally tubeless versus standard PNL Totally tubeless PNL may result in lower SAE rates (RR 0.49, 95% CI 0.19 to 1.25; I2 = 0%; 2 studies, 174 participants; low-certainty evidence) and pain on postoperative day one (MD 3.60 lower, 95% CI 4.24 lower to 2.96 lower; I2 = Not applicable; 1 study, 50 participants; low-certainty evidence). Totally tubeless PNL may result in little to no difference in operating room time (MD 6.23 shorter (in minutes), 95% CI 14.29 shorter to 1.84 longer; I2 = 72%; 2 studies, 174 participants; moderate-certainty evidence) and sepsis or fever (RR 0.33, 95% CI 0.01 to 7.97; I2 = not applicable; 1 study, 90 participants; low-certainty evidence). Totally tubeless PNL likely shortens the length of hospital stay (MD 1.55 shorter, 95% CI 1.82 shorter to 1.29 shorter; I2 = 0%; 4 studies, 274 participants; moderate-certainty evidence). We are very uncertain of the effect of totally tubeless PNL on blood transfusions (RR 0.62, 95% CI 0.26 to 1.48; I2 = 0%; 4 studies, 274 participants; very low-certainty evidence) or readmissions (RR not estimable, 95% CI not estimable; I2 = not applicable; 1 study, 50 participants; very low-certainty evidence). We found no studies comparing tubeless mini versus standard mini-PNL or totally tubeless mini versus standard mini-PNL.

Authors' conclusions: When comparing tubeless to standard PNL with regard to the predefined primary outcomes of this review, there may be little difference in early postoperative pain, while we are very uncertain of the effect on SAEs. People treated with tubeless PNL may benefit from a reduced length of stay compared to standard PNL. When comparing totally tubeless to standard PNL, early postoperative pain and severe adverse events may be reduced with totally tubeless PNL. The certainty of evidence by outcome was mostly very low (range: moderate to very low) for the comparison of tubeless to standard PNL and low (range: moderate to very low) for the comparison of totally tubeless to standard PNL. The most common reasons for downgrading the certainty of the evidence were study limitations, inconsistency, and imprecision. We did not find randomized trial evidence for other comparisons. Overall, further and higher-quality studies are needed to inform clinical practice.

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Conflict of interest statement

KW: none known.

SH: none known.

FK: is a Contact Editor for Cochrane Urology; however, he was not involved in the editorial process of this review.

MS:

  1. Schoelly GmbH, Denzlingen, Germany: Consultant (not related to tubeless PNL)

  2. LUT GmbH, Denzlingen, Germany: performing workshops for 'Ultra‐mini PNL' (not related to tubeless PNL)

  3. Neotract Inc., Pleasanton, CA, USA: performing workshops (for 'Urolift' for the treatment of lower urinary tract symptoms)

Two pending patents:

  1. gel‐forming system for removing urinary calculi and fragments thereof;

  2. kit for producing a cross‐linked gel to surround urinary calculi and/or fragments thereof.

The patents have been submitted and will be owned by the collaborating institutions (University Medical Center Freiburg and Fraunhofer Institute Munich) on 22 August 2013. MS is participating as an inventor.

The patents are pending (patents have been accepted by the European Patent Office, but a period for objection is still in progress).

The patents are not related to a competing intervention; they do not relate to whether tubes are used or not.

SS: none known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 Tubeless PNL versus standard PNL, outcome: 1.1 Severe adverse events.
5
5
Forest plot of comparison: 1 Tubeless PNL versus standard PNL, outcome: 1.2 Postoperative pain day 1.
6
6
Forest plot of comparison: 1 Tubeless PNL versus standard PNL, outcome: 1.3 Operating time (min).
7
7
Forest plot of comparison: 1 Tubeless PNL versus standard PNL, outcome: 1.4 Length of hospital stay (days).
8
8
Forest plot of comparison: 1 Tubeless PNL versus standard PNL, outcome: 1.5 Stone‐free rate.
9
9
Forest plot of comparison: 1 Tubeless PNL versus standard PNL, outcome: 1.8 Urinary leakage.
10
10
Forest plot of the comparison: 2 Totally tubeless PNL versus standard PNL, outcome: 2.1 Severe adverse events (Clavien grade 3 to 5).
11
11
Forest plot of comparison: 2 Totally tubeless PNL versus standard PNL, outcome: 2.3 Operating time (min).
12
12
Forest plot of comparison: 2 Totally tubeless PNL versus standard PNL, outcome: 2.4 Length of hospital stay (days).
13
13
Forest plot of comparison: 2 Totally tubeless PNL versus standard PNL, outcome: 2.6 Blood transfusion.
1.1
1.1. Analysis
Comparison 1: Tubeless PNL versus standard PNL, Outcome 1: Severe adverse events
1.2
1.2. Analysis
Comparison 1: Tubeless PNL versus standard PNL, Outcome 2: Postoperative pain day 1
1.3
1.3. Analysis
Comparison 1: Tubeless PNL versus standard PNL, Outcome 3: Operating time (min)
1.4
1.4. Analysis
Comparison 1: Tubeless PNL versus standard PNL, Outcome 4: Length of hospital stay (days)
1.5
1.5. Analysis
Comparison 1: Tubeless PNL versus standard PNL, Outcome 5: Stone‐free rate
1.6
1.6. Analysis
Comparison 1: Tubeless PNL versus standard PNL, Outcome 6: Blood transfusion
1.7
1.7. Analysis
Comparison 1: Tubeless PNL versus standard PNL, Outcome 7: Sepsis or fever
1.8
1.8. Analysis
Comparison 1: Tubeless PNL versus standard PNL, Outcome 8: Urinary leakage
1.9
1.9. Analysis
Comparison 1: Tubeless PNL versus standard PNL, Outcome 9: Readmission (first 30 days)
2.1
2.1. Analysis
Comparison 2: Totally tubeless PNL versus standard PNL, Outcome 1: Severe adverse events
2.2
2.2. Analysis
Comparison 2: Totally tubeless PNL versus standard PNL, Outcome 2: Postoperative pain day 1
2.3
2.3. Analysis
Comparison 2: Totally tubeless PNL versus standard PNL, Outcome 3: Operating time (min)
2.4
2.4. Analysis
Comparison 2: Totally tubeless PNL versus standard PNL, Outcome 4: Length of hospital stay (days)
2.5
2.5. Analysis
Comparison 2: Totally tubeless PNL versus standard PNL, Outcome 5: Stone‐free rate
2.6
2.6. Analysis
Comparison 2: Totally tubeless PNL versus standard PNL, Outcome 6: Blood transfusion
2.7
2.7. Analysis
Comparison 2: Totally tubeless PNL versus standard PNL, Outcome 7: Sepsis or fever
2.8
2.8. Analysis
Comparison 2: Totally tubeless PNL versus standard PNL, Outcome 8: Urinary leakage
2.9
2.9. Analysis
Comparison 2: Totally tubeless PNL versus standard PNL, Outcome 9: Readmission (first 30 days)
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References

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Istanbulluoglu 2010 {published data only}
    1. Istanbulluoglu MO, Cicek T, Ozturk B, Gonen M, Ozkardes H. Percutaneous nephrolithotomy: nephrostomy or tubeless or totally tubeless? Urology 2010;75(5):1043-1046. [DOI: ] - PubMed
Istanbulluoglu 2013 {published data only}
    1. Istanbulluoglu MO, Kaynar M, Cicek T, Kosan M, Ozturk B, Ozkardes H. A new hemostatic agent (Ankaferd Blood Stopper) in tubeless percutaneous nephrolithotomy: A prospective randomized study. Journal of Endourology 2013;27(9):1126-1130. [DOI: ] - PubMed
Jun Ou 2010 {published data only}
    1. Jun-Ou J, Lojanapiwat B. Supracostal access: Does it affect tubeless percutaneous nephrolithotomy efficacy and safety? International Braz J Urol 2010;36(2):171-176. [DOI: ] - PubMed
Kara 2010 {published data only}
    1. Kara C, Resorlu B, Bayindir M, Unsal A. A randomized comparison of totally tubeless and standard percutaneous nephrolithotomy in elderly patients. Urology 2010;76(2):289-293. [DOI: ] - PubMed
Karadeniz 2010 {published data only}
    1. Karadeniz T, Baran C, Topsakal M, Ozkaptan O. A safe technique for control of bleeding after percutaneous nephrolithotomy. Current Urology 2010;4(1):33-6. [DOI: 10.1159/000253406] - DOI
Karami 2004 {published data only}
    1. Karami H, Gholamrezaie HR. Totally tubeless percutaneous nephrolithotomy in selected patients. Journal of Endourology 2004;18(5):475-476. [DOI: 10.1089/0892779041271580] - DOI - PubMed
Kumar 2016 {published data only}
    1. Kumar S, Singh S, Singh P, Singh SK. Day care PNL using 'Santosh-PGI hemostatic seal' versus standard PNL: A randomized controlled study. Cent European J Urol 2016;69:190-197. - PMC - PubMed
Kumar 2017 {published data only}
    1. Kumar A, Singh SK, Pawar DS, Yadav L, Mittal S. To evaluate the applications of totally tubeless mini percutaneous nephrolithotomy (PCNL) and compare it with standard mini PCNL. Indian Journal of Urology 2017;33:(no pagination).
Lee 2015 {published data only}
    1. Lee JW, Park J, Lee SB, Son H, Cho SY, Jeong H. Mini-percutaneous nephrolithotomy vs retrograde intrarenal surgery for renal stones larger lhan 10 mm: A prospective randomized controlled trial. Urology 2015;86(5):873-877. - PubMed
Li 2011 {published data only}
    1. Li R, Louie MK, Lee HJ, Osann K, Pick DL, Santos RS, et al. Prospective randomized trial of three different methods of nephrostomy tract closure after percutaneous nephrolithotripsy. BJUI 2011;107:1660-1665. - PubMed
Liatsikos 2002 {published data only}
    1. Liatsikos EN, Hom D, Dinlenc CZ, Kapoor R, Alexianu M, Yohannes P, et al. Tail stent versus re-entry tube: A randomized comparison after percutaneous stone extraction. Urology 2002;59(1):15-19. [DOI: ] - PubMed
Lu 2012 {published data only}
    1. Lu Y, Ping J, Zhao X, Hu L, Pu J. Randomized prospective trial of tubeless versus conventional minimally invasive percutaneous nephrolithotomy. World Journal of Urology 2013;31:1303-1307. - PubMed
Ma 2013 {published data only}
    1. Ma N, Chen H, Luo Y, Long X, Zeng F, Wang J, et al. Foley catheter traction for hemorrhage after post microchannel percutaneous nephrolithotomy. Journal of Central South University (Medical Sciences) 2013;38(1):86-89. [DOI: ] - PubMed
Mandhani 2007 {published data only}
    1. Mandhani A, Goyal R, Vijjan V, Dubey D, Kapoor R. Tubeless percutaneous nephrolithotomy—should a stent be an integral part? Journal of Urology 2007;178(3):921-924. [DOI: 10.1016/j.juro.2007.05.021] - DOI - PubMed
Marcovich 2004 {published data only}
    1. Marcovich R, Jacobson AI, Singh J, Shah D, El-Hakim A, Lee BR, et al. No panacea for drainage after percutaneous nephrolithotomy. Journal of Endourology 2004;18(8):743-7. [DOI: 10.1089/end.2004.18.743] - DOI - PubMed
Mercado 2013 {published data only}
    1. Mercado A, Fernández MI, Recabal P, Fleck D, Ledezma R, Moya F, et al. Immediate postoperative morbidity in patients with indwelling double-J stent versus overnight-externalized ureteral catheter after tubeless percutaneous nephrolithotomy: a prospective, randomized study. Urolithiasis 2013;41(3):253-6. [DOI: 10.1007/s00240-013-0555-x] - DOI - PubMed
Millard 2009 {published data only}
    1. Millard WW, Jellison FC, Tenggardjaja CF, Nicolay LI, Baldwin DD. The hemostatic sandwich: A tamponade method for controlling severe bleeding in percutaneous kidney stone surgery. Journal of Investigative Medicine 2009;57(1):148-148.
Monga 2008 {published data only}
    1. Monga M. Percutaneous nephrolithotomy: leave a tube! Journal of Endourology 2008;22(9):1863-4; discussion 1871. [DOI: ] - PubMed
Moosanejad 2016a {published data only}
    1. Moosanejad N, Firouzian A, Hashemi SA, Bahari M, Fazli M. Comparison of totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for kidney stones: A randomized, clinical trial. Brazilian Journal of Medical and Biological Research 2016;49(4):e4878. [DOI: ] - PMC - PubMed
NCT01437904 {published data only}
    1. NCT01437904. A pilot study assessing the feasibility of outpatient tubeless percutaneous nephrolithotomy (PCNL). clinicaltrials.gov/ct2/show/NCT01437904 (first received 21 September 2011).
NCT02036398 {published data only}
    1. NCT02036398. Tubeless versus standard upper pole percutaneous nephrolithotomy. clinicaltrials.gov/ct2/show/NCT02036398 2014.
NCT03907930 {published data only}
    1. NCT03907930. Comparative study between tubeless and standard percutaneous nephrolithotomy. Randomized. clinicaltrials.gov/ct2/show/NCT03907930 2019.
Nirmal 2009 {published data only}
    1. Nirmal TJ, Samiran A. Totally tubeless percutaneous nephrolithotomy: Is it safe. Indian Journal of Urology 2009;25(3):418-419.
Okeke 2009 {published data only}
    1. Okeke Z, Andonian S, Srinivasan A, Shapiro E, Vanderbrink BA, Kavoussi LR, et al. Cryotherapy of the nephrostomy tract: a novel technique to decrease the risk of hemorrhage after tubeless percutaneous renal surgery. Journal of Endourology 2009;23(3):417-20. [DOI: ] - PubMed
Ozturk 2015 {published data only}
    1. Ozturk H. Tubeless versus standard PCNL in geriatric population. Actas Urologicas Espanolas 2015;39(8):494-501. [DOI: 10.1016/j.acuro.2015.02.010] - DOI - PubMed
Pietrow 2003 {published data only}
    1. Pietrow PK, Auge BK, Lallas CD, Santa-Cruz RW, Newman GE, Albala DM, et al. Pain after percutaneous nephrolithotomy: impact of nephrostomy tube size. Journal of Endourology 2003;17(6):411-4. [DOI: 10.1089/089277903767923218] - DOI - PubMed
Portis 2004 {published data only}
    1. Portis AJ, Laliberte MA, Drake S, Scheltema K, Rosenberg MS, Bretzke CA. Tubeless percutaneous nephrolithotomy: Efficacy and safety for large volume nephrolithiasis. Journal of Urology 2004;171(4):501-502.
Sabnis 2014 {published data only}
    1. Sabnis R, Ganpule A, Mishra S, Vyas J, Ganeshmoni R, Jagtap J, et al. Exit strategy following MPNL—prospective randomized study. Journal of Urology 2014;191(4 suppl. 1):e187. [DOI: 10.1016/j.juro.2014.02.699] - DOI
Sebaey 2016 {published data only}
    1. Sebaey A, Khalil MM, Soliman T, Mohey A, Elshaer W, Kandil W, et al. Standard versus tubeless mini-percutaneous nephrolithotomy: A randomised controlled trial. Arab Journal of Urology 2016;14 (1):18-23. - PMC - PubMed
Shah 2006 {published data only}
    1. Shah HN, Hegde S, Shah JN, Mohile PD, Yuvaraja TB, Bansal MB. A prospective, randomized trial evaluating the safety and efficacy of fibrin sealant in tubeless percutaneous nephrolithotomy. Journal of Urology 2006;176(6):2488-2493. [DOI: ] - PubMed
Shoma 2012 {published data only}
    1. Shoma AM, Elshal AM. Nephrostomy tube placement after percutaneous nephrolithotomy: critical evaluation through a prospective randomized study. Urology 2012;79(4):771-6. [DOI: 10.1016/j.urology.2011.09.042] - DOI - PubMed
Singh 2008 {published data only}
    1. Singh I, Singh A, Mittal G. Tubeless percutaneous nephrolithotomy: is it really less morbid? Journal of Endourology 2008;22(3):427-34. [DOI: ] - PubMed
Singh 2013 {published data only}
    1. Singh BP, Sankhwar SN. Tubeless percutaneous nephrolithotomy for complex renal calculi and complicated procedures. Journal of Urology 2013;189(4):E631-E631.
Su 2015 {published data only}
    1. Su H, Zhu Y, Deng Q, Pei L, Wang J. Application of nephrostomy tubes with balloon after percutaneous nephrolithotomy: A randomized controlled clinical trial. International Journal of Urology 2015;22(12):1118-1121. [DOI: ] - PubMed
Taghavi 2011 {published data only}
    1. Taghavi R, Reza M, Mahboub D. Comparison of the results and complications between standard and tubeless percoutaneous nephrolithotomy. Journal of Endourology / Endourological Society 2011;25:A6. [DOI: 10.1089/end.2011.2003.supp] - DOI
Tefekli 2007 {published data only}
    1. Tefekli A, Altunrende F, Tepeler K, Tas A, Aydin S, Muslumanoglu AY. Tubeless percutaneous nephrolithotomy in selected patients: a prospective randomized comparison. International Urology and Nephrology 2007;39(1):57-63. [DOI: 10.1007/s11255-006-9040-6] - DOI - PubMed
Telha 2010 {published data only}
    1. Telha KA, Alba'adani TH, Alkohlany KM, Al-Adimy AO, Alnono IH. Tubeless percutaneous nephrolithotomy with double-J stent compared with external ureteral catheter to decrease postoperative complications. Saudi Medical Journal 2010;31(10):1137-40. - PubMed
Yoon 2008 {published data only}
    1. Yoon GH, Bellman GC. Tubeless percutaneous nephrolithotomy: a new standard in percutaneous renal surgery. Journal of Endourology 2008;22(9):1865-7; discussion 1869. [DOI: ] - PubMed
Yun 2012 {published data only}
    1. Yun SI, Lee YH, Kim JS, Cho SR, Kim BS, Kwon JB. Comparative study between standard and totally tubeless percutaneous nephrolithotomy. Korean Journal of Urology 2012;53(11):785-9. [DOI: 10.4111/kju.2012.53.11.785] - DOI - PMC - PubMed
Zhao 2016 {published data only}
    1. Zhao P, Gaunay GS, Hoenig DM, Smith AD, Okeke Z. A randomized controlled comparison of nephrostomy drainage versus ureteral stent following percutaneous nephrolithotomy using the Wisconsin StoneQOL. Journal of Endourology 2016;30:A378. [DOI: ] - PubMed
Zhao 2016a {published data only}
    1. Zhao PT, Hoenig DM, Smith AD, Okeke Z. A randomized controlled comparison of nephrostomy drainage vs ureteral stent following percutaneous nephrolithotomy using the Wisconsin stone QOL. Journal of Endourology 2016;30(12):1275-1284. [DOI: ] - PubMed
Zhou 2017 {published data only}
    1. Zhou Y, Zhu J, Gurioli A, Yuan D, Luo J, Li Z, et al. Randomized study of ureteral catheter vs double-J stent in tubeless minimally invasive percutaneous nephrolithotomy patients. Journal of Endourology 2017;31(3):278-282. [DOI: ] - PubMed
Ziaee 2013 {published data only}
    1. Ziaee SAM, Sarhangnejad R, Abolghasemi H, Eshghi P, Radfar MH, Ahanian A, et al. Autologous fibrin sealant in tubeless percutaneous nephrolithotomy; a prospective study. Urology Journal 2013;10(3):999-1003. - PubMed

References to studies awaiting assessment

Folin 2017 {published data only}
    1. Folin L, Xiaofeng Z, Rihai X, Yuanhu Y, Gengqing W, Xiaoning W, et al. A prospective randomized controlled study of instantly phase-II tubeless percutaneous nephrolithotomy. European Urology 2017;16(3):e968.
Gyawali 2017 {published data only}
    1. Gyawali P. Tubeless vs totally tubeless percutaneous lithotripsy—a randomised control trial. International Journal of Urology. Conference: 14th Asian Congress of Urology of the Urological Association of Asia, ACU 2016. Singapore. Conference start: 20160720. Conference end: 20160724. Conference publication: (var.pagings) 2017;23:92. [DOI: 10.1111/iju.13149] - DOI
IRCT201204169485N1 {published data only}
    1. IRCT201204169485N1. Comparison between kidney stone surgery through the skin, without nephrostomy tube method and without any tube method versus classic method. Clinical Trial Registry 2012. [https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT201204169485N1]
IRCT201611019014N129 {published data only}
    1. IRCT201611019014N129. Comparison of the adverse effect of two methods of nephrolithotomy in patients having kidney stone. Clinical Trial Registry 2016. [https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT201611019014N129]
Murali 2015 {published data only}
    1. Murali V. Exit strategy following Mini-PNL—prospective randomized study. In: Indian Journal of Urology. Vol. 31. 2015:S53-S54.
NCT01548196 {published data only}
    1. NCT01548196. Standard percutaneous nephrolithotomy percutaneous nephrolithotomy (PNL) versus tubeless PNL versus tubeless stentless PNL. Clinical Trial Registry 2011. [https://clinicaltrials.gov/ct2/show/NCT01548196]
Ramasamy 2019 {published data only}
    1. Ramasamy N, Balasubramanyan JK, Thirunavukarasu C, Kumerasan N, Reddy G. Efficacy and safety of standard versus tubeless percutaneous nephrolithotomy—a randomized controlled study. Journal of Evolution of Medical and Dental Sciences-Jemds 2019;8(25):2002-2006.
Taghavi 2013 {published data only}
    1. Taghavi R, Darabi MR, Jahed, Ataeian S. Comparison of the results and complications between standard and tubeless percoutaneous nephrolithotomy. European Urology, Supplements 2013;12(4):e1337. [DOI: 10.1016/S1569-9056%2813%2962262-9] - DOI

References to ongoing studies

CTRI/2018/07/015022 {published data only}
    1. CTRI/2018/07/015022. Comparison of two surgeries—standard and tubeless percutaneous nephrolithotomy for the treatment of kidney stones—a prospective randomized control study. clinical trial registry 2018. [https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2018/07/015022]
NCT04069013 {unpublished data only}
    1. Randomized Controlled Trial Comparing Surgical Outcomes Following PCNL and Mini PCNL in the Treatment of Kidney Stones. [https://clinicaltrials.gov/ct2/show/NCT04069013]

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References to other published versions of this review

Wilhelm 2017
    1. Wilhelm K, Hein S, Kunath F, Schoenthaler M, Schmidt S. Tubeless versus tubed percutaneous nephrolithotomy for treating kidney stones. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No: CD012607. [DOI: 10.1002/14651858.CD012607] - DOI - PMC - PubMed

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