Elevated intrarenal pressure (IRP) during percutaneous nephrolithotomy (PCNL) is linked to postoperative infectious morbidity. This systematic review and meta-analysis evaluated suction-assisted PCNL versus conventional PCNL regarding IRP and clinical outcomes.
Registered in PROSPERO (CRD420251235580), this study followed PRISMA guidelines. Primary outcome was IRP; secondary outcomes included postoperative fever, sepsis, Clavien-Dindo ≥ 2 complications, operative time, hospital stay, and stone-free rate. Random-effects models and I2 statistics were used. Bias was assessed via Cochrane ROB-2 and ROBINS-I tools.
Eight studies involving 1,171 patients (577 suction-assisted; 594 conventional) were included. Quantitative synthesis of six studies showed suction-assisted PCNL maintained significantly lower IRP (2.7-16.9 mmHg) compared to conventional groups (15.4 to > 30 mmHg), effectively preventing prolonged episodes of ≥ 30 mmHg. Suction-assisted PCNL was associated with significantly lower risks of postoperative fever and Clavien-Dindo ≥ 2 complications. Pooled analysis suggested reduced sepsis risk, though confidence intervals were wide due to low event rates. Suction cohorts reported no pressure-related severe infections. Additionally, suction-assisted PCNL demonstrated shorter operative times, shorter hospital stays, and higher stone-free rates. Heterogeneity was low to moderate across most outcomes.
Suction-assisted PCNL provides superior IRP control and more favorable perioperative outcomes than conventional PCNL. While these systems appear to reduce infectious morbidity and complications, additional high-quality randomized controlled trials are required for confirmation.
World journal of urology. 2026 Jul 02*** epublish ***
Ümit Özdemir, Abdullah Altunhan, Mehmet Giray Sönmez, Steffi Kar Kei Yuen, Kamran Ahmed, Vineet Gauhar, Thomas R W Herrmann, Bhaskar Somani, Selçuk Güven
Department of Urology, Meram Faculty of Medicine, Necmettin Erbakan University, No:1, 42080, Meram/Konya, Turkey. ., Department of Urology, Meram Faculty of Medicine, Necmettin Erbakan University, No:1, 42080, Meram/Konya, Turkey., S.H. Ho Urology, Department of Surgery, The Chinese University of Hong Kong, Sha Tin, Hong Kong., King's College London, London, UK., Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore., Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland., University of Southampton, Southampton, UK.