To systematically review the efficacy and safety of totally tubeless percutaneous nephrolithotomy (PCNL) and standard PCNL in management of kidney stones.

PubMed, Embase and Cochrane Library were searched from the beginning of database to February 28, 2018. Randomised controlled trials (RCT) and retrospective case-control study (CCS) that compared the two above operation for treatment of kidney stones were collected. Two researchers independently filtered literature and extracted data. The meta-analysis was performed using the RevMan 5.3 software.

Five RCT and two CCS including 781 patients, which consists of 379 cases totally tubeless PCNL and 402 cases standard PCNL. The results of meta-analysis showed that compared with standard PCNL, the totally tubeless PCNL showed shorter operation time (WMD: -2.72; 95%CI: -4.05 to -1.39; P<0.001), shorter hospital stay (WMD: -1.48; 95%CI: -1.84 to -1.11; P<0.001), lower analgesic requirement (WMD: -6.91; 95%CI: -9.00 to -4.82; P<0.001). There was no significant difference in stone-free rate, hemoglobin decrease and blood transfusion between the two groups.

Totally tubeless PCNL is better than standard PCNL in the management of selected kidney stone patients, with significantly shorter operative time, shorter hospital stay, lower analgesic requirement, and don't increase relevant operation morbidity. Selection of the treatment plan should base on the actual situation of the patients personally.