Enhanced stone-free rates with suctioning ureteral access sheath vs. traditional sheath in retrograde intrarenal surgery: a systematic review and meta-analysis

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

As a safe approach to the upper urinary tract, flexible ureteroscopic lithotripsy (fURL) is a widely accepted treatment for nephrolithiasis. Sometimes, this technique can rely on the natural expulsion of stones, increasing the risk of infections and stone recurrence. To mitigate these issues, some studies tried to use a suctioning ureteral access sheath (S-UAS).

Methods

A systematic review was conducted across multiple databases for trials comparing S-UAS with traditional (T-UAS) in retrograde intrarenal surgery (RIRS). The primary endpoint was the stone-free rate (SFR), while adverse effects, operative time, fever rate, and hospital stay were analyzed as secondary outcomes.

Results

We retrieved 8 articles, encompassing a total of 2,255 patients, with 978 in the S-UAS group and 1,247 in the T-UAS group. Our analysis revealed a higher SFR in the S-UAS group after 1 day, and also at later time points (one or three months) (OR 3.79; 95% CI 1.70–8.46; p = 0.001; I ² = 89.2%) and (OR 1.98; 95% CI 1.52–2.59; p < 0.001; I ² = 0%), respectively. Regarding surgical complications, we observed a lower incidence in the S-UAS group (OR 0.37; 95% CI 0.26–0.51; p < 0.001; I ² = 0%), as well as a reduced fever rate (OR 0.34; 95% CI 0.24–0.48; p < 0.001; I ² = 0%) and a shorter length of hospital stay (MD -0.11; 95% CI -0.16 to -0.05; p < 0.001; I ² = 39.6%). No differences were found in the operative time between both approaches (MD -2.49; 95% CI -7.62–2.65; p < 0.343; I ² = 88.3%).

Conclusion

Our study suggests that using S-UAS in RIRS may enhance the SFR, and also reduce both complications and hospital stay.

Trial registration

This systematic-review and meta-analysis was prospectively registered on PROSPERO under protocol CRD42024543084.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12894-025-01775-x.

Related collections

Most cited references 24

Record: found
Abstract: found
Article: found

RoB 2: a revised tool for assessing risk of bias in randomised trials

Jonathan A C Sterne, Jelena Savović, Matthew J L Page … (2023)

0 comments Cited 8504 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: found

Is Open Access

ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions

Jonathan AC Sterne, Miguel A. Hernán, Barnaby Reeves … (2019)

Non-randomised studies of the effects of interventions are critical to many areas of healthcare evaluation, but their results may be biased. It is therefore important to understand and appraise their strengths and weaknesses. We developed ROBINS-I (“Risk Of Bias In Non-randomised Studies - of Interventions”), a new tool for evaluating risk of bias in estimates of the comparative effectiveness (harm or benefit) of interventions from studies that did not use randomisation to allocate units (individuals or clusters of individuals) to comparison groups. The tool will be particularly useful to those undertaking systematic reviews that include non-randomised studies.

0 comments Cited 5164 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

The Clavien-Dindo classification of surgical complications: five-year experience.

Pierre A. Clavien, Jeffrey Barkun, Michelle L. de Oliveira … (2009)

The lack of consensus on how to define and grade adverse postoperative events has greatly hampered the evaluation of surgical procedures. A new classification of complications, initiated in 1992, was updated 5 years ago. It is based on the type of therapy needed to correct the complication. The principle of the classification was to be simple, reproducible, flexible, and applicable irrespective of the cultural background. The aim of the current study was to critically evaluate this classification from the perspective of its use in the literature, by assessing interobserver variability in grading complex complication scenarios and to correlate the classification grades with patients', nurses', and doctors' perception. Reports from the literature using the classification system were systematically analyzed. Next, 11 scenarios illustrating difficult cases were prepared to develop a consensus on how to rank the various complications. Third, 7 centers from different continents, having routinely used the classification, independently assessed the 11 scenarios. An agreement analysis was performed to test the accuracy and reliability of the classification. Finally, the perception of the severity was tested in patients, nurses, and physicians by presenting 30 scenarios, each illustrating a specific grade of complication. We noted a dramatic increase in the use of the classification in many fields of surgery. About half of the studies used the contracted form, whereas the rest used the full range of grading. Two-thirds of the publications avoided subjective terms such as minor or major complications. The study of 11 difficult cases among various centers revealed a high degree of agreement in identifying and ranking complications (89% agreement), and enabled a better definition of unclear situations. Each grade of complications significantly correlated with the perception by patients, nurses, and physicians (P < 0.05, Kruskal-Wallis test). This 5-year evaluation provides strong evidence that the classification is valid and applicable worldwide in many fields of surgery. No modification in the general principle of classification is warranted in view of the use in ongoing publications and trials. Subjective, inaccurate, or confusing terms such as "minor or major" should be removed from the surgical literature.

0 comments Cited 2450 times – based on 0 reviews      Review now

All references

Author and article information

Contributors

Jose Arnaldo Shiomi Da Cruz:

ORCID: http://orcid.org/0000-0003-4203-3196

arnaldoshiomi@yahoo.com.br

Journal

Journal ID (nlm-ta): BMC Urol

Journal ID (iso-abbrev): BMC Urol

Title: BMC Urology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2490

Publication date (Electronic): 11 April 2025

Publication date PMC-release: 11 April 2025

Publication date Collection: 2025

Volume: 25

Electronic Location Identifier: 86

Affiliations

[1 ]Surgical Technique and Experimental Surgery Department, University of São Paulo School of Medicine, ( https://ror.org/036rp1748) São Paulo, SP Brazil

[2 ]International Teaching and Research Institute - Hapvida NotreDame Intermédica, Fortaleza, Brazil

[3 ]Ninth of July University, Sao Bernardo do Campo, SP Brazil

Author information

Felipe Giraldo Alvarez Gonçalves http://orcid.org/0009-0001-3931-9196

Breno Cordeiro Porto http://orcid.org/0000-0002-4004-4089

Bruno Damico Terada http://orcid.org/0009-0004-3962-8951

João Victor Gruner Turco Spilborghs http://orcid.org/0009-0007-9800-9503

Carlo Camargo Passerotti http://orcid.org/0000-0003-3023-6797

Rodrigo A. S. Sardenberg http://orcid.org/0000-0002-6010-1829

Jose Pinhata Otoch http://orcid.org/0000-0002-8293-1508

Jose Arnaldo Shiomi Da Cruz http://orcid.org/0000-0003-4203-3196

Article

Publisher ID: 1775

DOI: 10.1186/s12894-025-01775-x

PMC ID: 11987389

PubMed ID: 40217207

SO-VID: de28a843-dded-46a9-8257-4b680336bad3

License:

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

History

Date received : 29 December 2024

Date accepted : 3 April 2025

Custom metadata

ScienceOpen disciplines: Urology

Keywords: ureterolithiasis,urinary calculi,systematic review,meta-analysis

Data availability: