Papillary and non-papillary access techniques yield comparable clinical outcomes in percutaneous nephrolithotomyPapillary Access Shows Similar Results to Standard Kidney Stone Surgery

BACKGROUND: Percutaneous nephrolithotomy (PCNL) access is traditionally obtained via papillary puncture to minimize bleeding, though non-papillary access is frequently utilized in everyday clinical practice due to practical considerations such as anatomical variations and stone location. Because existing comparative studies have yielded inconsistent findings, this systematic review and meta-analysis aimed to synthesize existing evidence evaluating the safety and efficacy of papillary versus non-papillary access during PCNL. METHODS: A comprehensive systematic search of databases, including PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov, alongside grey literature, was conducted from inception until December 2025. Randomized controlled trials and observational studies comparing papillary and non-papillary access for renal calculi in patients undergoing PCNL were included. Data were pooled using a random-effects model to calculate mean differences (MD) and odds ratios (OR) alongside their 95% confidence intervals (CIs). RESULTS: A total of six studies comprising 856 patients met the inclusion criteria. Pooled analyses demonstrated no statistically significant differences between the papillary and non-papillary access groups regarding hemoglobin drop (MD 0.09 g/dL, 95% CI -0.19 to 0.37), transfusion rates (OR 1.28, 95% CI 0.59 to 2.74), changes in postoperative serum creatinine levels (MD 0.02 mg/dL, 95% CI -0.03 to 0.07), duration of hospital stay (MD 0.08 days, 95% CI -0.28 to 0.44), stone-free status (OR 1.20, 95% CI 0.76 to 1.89), or operative duration (MD 2.81 min, 95% CI -2.06 to 7.68). Heterogeneity across most outcomes was minimal. Meta-regression identified stone size as the only significant moderator, which negatively influenced operative duration. CONCLUSION: Papillary and non-papillary access techniques during PCNL appear to provide comparable clinical outcomes with no significant differences in major perioperative parameters. The clinical decision-making regarding the selection of access technique should be individualized, considering patient anatomy, stone characteristics, and surgical expertise rather than strict adherence to a single standardized puncture strategy.