Comparison between papillary and non-papillary access for percutaneous nephrolithotomy: a systematic review and meta-analysis
In brief
Two kidney stone access routes had similar results across 985 patients
A review of eight studies found similar stone-free rates, bleeding, transfusions, complications and hospital stays with papillary and non-papillary access for kidney stone surgery. Papillary access took slightly longer, but the difference was judged clinically insignificant. With only three randomized trials, the evidence supports tailoring access to patient anatomy and surgeon experience rather than favoring one route.
- Journal
- Minerva urology and nephrology (Q1)
- Published
- 13 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Yuhan Xiao, Yuehua Wang, Wuran Wei
- PMID
- 42867475
- DOI
- 10.23736/S2724-6051.26.06955-7
Why clinicians should know about it
- Picked for Anatomy (paper of the day, 14 October 2026): Papillary vs non‑papillary PCNL anatomical comparison
Abstract
BACKGROUND: Percutaneous nephrolithotomy (PCNL) is first-line treatment for large or complex renal calculi. The traditional papillary access is considered safer, while non-papillary access may offer procedural advantages. This systematic review and meta-analysis aims to evaluate the efficacy and safety of papillary versus non-papillary approaches in PCNL for the management of kidney stones. METHODS: Eligible studies were identified by searching the PubMed, Web of Science, Scopus, Embase, and the Cochrane Library databases for relevant reports published until November 2025. Outcome measures included stone-free rate (SFR), fluoroscopy time, operation time, blood loss, transfusion rates, change in serum creatinine, hospital stay, and complications. Risk ratio (RR), weighted mean difference (WMD) and standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects models. Two reviewers independently assessed the quality of all included studies, and statistical analyses were performed using R software. RESULTS: Eight studies involving 985 patients were included, three of which were randomized controlled trials. Post-PCNL SFR showed no significant difference between the papillary and non-papillary approach groups (fixed-effects model: RR=1.01, 95% CI: 0.94 to 1.07, P=0.858). Similarly, no statistically significant differences were found between the two groups in transfusion rates (RR=1.32; 95% CI: 0.75 to 2.30; P=0.336), blood loss (WMD=0.11; 95% CI: -0.22 to 0.44; P=0.519), fluoroscopy time (WMD=0.15; 95% CI: -0.07 to 0.38; P=0.185), hospital stay (WMD= -0.01; 95% CI: -0.15 to 0.13; P=0.911), or changes in serum creatinine (WMD=0.00; 95% CI: -0.05 to 0.05; P=0.893). Moreover, complication rates were comparable between papillary access and non-papillary access. Although operative time was slightly longer in the papillary group (SMD=0.16; 95% CI: 0.03 to 0.29; P=0.014), this difference was clinically insignificant. CONCLUSIONS: Both papillary and non-papillary access are suitable for most PCNL procedures, demonstrating comparable efficacy and safety. The optimal approach should be determined by patient anatomy and surgeon expertise.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.