To evaluate the effectiveness and safety of ultrasound-guided percutaneous nephrolithotomy (UG-PCNL) compared to fluoroscopy-guided PCNL (FG-PCNL) for kidney stone management, focusing on clinical outcomes and procedural efficiency.

A systematic review and meta-analysis of randomized controlled trials was conducted following preferred reporting items for systematic reviews and meta-analyses guidelines. Searches were performed in PubMed, Excerpta Medica Database (EMBASE), Scopus, and Web of Science for studies published between 2000 and 2024. Primary outcomes included stone-free rate (SFR), needle puncture time, calculus clearance rate, and access time. Secondary outcomes involved single needle puncture success rate (SNPSR), hospital stay duration, total complication rate, urosepsis, fever, and postoperative serum creatinine.

Analysis of 21 randomized controlled trials with 2969 patients showed no significant difference in stone-free rate between UG-PCNL and FG-PCNL (odds ratios: 0.93, 95% CI: 0.77-1.13; P = .47). UG-PCNL significantly reduced access time (Standardized mean difference: 0.68, 95% CI: 0.06-1.30; P = .03), while other outcomes like SNPSR and puncture time showed no significant differences. Complication rates, including urosepsis and fever, were comparable between techniques.

UG-PCNL is as effective as FG-PCNL, offering the benefits of radiation-free imaging and reduced access time, with comparable safety profiles. Further studies are needed to confirm the certainty of outcomes like SNPSR and bleeding rates.