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Objective <p>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.</p> Methods <p>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.</p> Results <p>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 &gt; 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.</p> Conclusions <p>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.</p>

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Intrarenal pressure and clinical outcomes during suction-assisted versus conventional percutaneous nephrolithotomy: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年7月2日

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  • Ümit Özdemir,
  • Abdullah Altunhan,
  • Mehmet Giray Sönmez,
  • Steffi Kar Kei Yuen,
  • Kamran Ahmed,
  • Vineet Gauhar,
  • Thomas R. W. Herrmann,
  • Bhaskar Somani,
  • Selçuk Güven

摘要

Objective

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.

Methods

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.

Results

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.

Conclusions

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.