Flexible and navigable suction ureteral access sheath versus traditional ureteral access sheath for flexible ureteroscopy in renal and proximal ureteral stones: a meta-analysis of efficacy and safety.

Authors

Qiang Liu, Ting Zeng, Shuxia Zhu

Published in

BMC urology. Volume 25. Issue 1. Pages 127. May 19, 2025. Epub May 19, 2025.

Abstract

Traditional ureteral access sheaths (T-UAS) are limited by rigidity and lack of suction, potentially increasing complications. Flexible and navigable suction ureteral access sheaths (FANS-UAS) offer improved maneuverability and active suction, but comparative evidence on their efficacy and safety is scarce. This meta-analysis evaluates FANS-UAS versus T-UAS in flexible ureteroscopy (fURS).
A systematic search across PubMed, Embase, Cochrane Library, and Web of Science (from inception to February 2025) identified studies comparing FANS-UAS and T-UAS. Included were RCTs and observational studies with ≥ 20 patients. Outcomes included stone-free rates (SFRs), operative time, hospital stay, and complications. Study quality was assessed using the Jadad Scale for RCTs and Newcastle-Ottawa Scale (NOS) for observational studies.
Eight studies (1 RCT, 7 observational; 1,816 patients: 866 FANS-UAS, 950 T-UAS) were analyzed. Compared to T-UAS, FANS-UAS demonstrated significantly higher stone-free rates (SFRs) at both postoperative day 1 (OR = 4.01, 95% CI: 1.98-8.11) and 30-day follow-up (OR = 2.37, 95% CI: 1.62-3.46). FANS-UAS was associated with a lower risk of postoperative fever (OR = 0.31, 95% CI: 0.21-0.47). Operative time trended longer with FANS-UAS (MD = 2.64 min, 95% CI: -2.56 to 7.84; p = 0.32), though without statistical significance, while hospital stay showed no difference between groups (MD = - 0.07 days, 95% CI: -0.16 to 0.01; p = 0.1).
FANS-UAS provides superior stone clearance and reduced complications versus T-UAS, with only slightly longer operative time. The integrated suction system enables these advantages through improved fragment removal and pressure control. Further RCTs should confirm these benefits.

PMID:
40389965
Bibliographic data and abstract were imported from PubMed on 20 May 2025.

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