Flexible and Navigable Suction Ureteral Access Sheaths for the Treatment of Urolithiasis: Systematic Review and Meta-analysis

IF 6.3 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus Pub Date : 2026-09-01 Epub Date: 2025-09-13 DOI:10.1016/j.euf.2025.08.008

Michael Uy, Joseph Moryousef, Lei Wang, Yanbo Guo, Edward D. Matsumoto, Stephanie Daignault-Newton, Wilson Sui, William W. Roberts, Casey A. Dauw, Khurshid R. Ghani

{"title":"Flexible and Navigable Suction Ureteral Access Sheaths for the Treatment of Urolithiasis: Systematic Review and Meta-analysis","authors":"Michael Uy, Joseph Moryousef, Lei Wang, Yanbo Guo, Edward D. Matsumoto, Stephanie Daignault-Newton, Wilson Sui, William W. Roberts, Casey A. Dauw, Khurshid R. Ghani","doi":"10.1016/j.euf.2025.08.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and objective</h3><div>Use of a flexible and navigable suction (FANS) ureteral access sheath (UAS) is increasing for evacuation of fragments during retrograde intrarenal surgery (RIRS) for upper tract stones. We compared the use of FANS-UAS and a traditional UAS (T-UAS) in terms of the stone-free rate (SFR) and adverse events, and captured data on FANS-UAS specifications and intraoperative settings currently being used in practice.</div></div><div><h3>Methods</h3><div>We performed a systematic review and meta-analysis of comparative and noncomparative studies in the Medline, Embase, and Cochrane databases (January 1, 2000 to March 30, 2025) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Assessing the Methodologic Quality of Systematic Reviews-2 guidelines (CRD42023466330). Preplanned subgroup analyses were performed for variations in the SFR definition and for studies that compared FANS-UAS to a T-UAS with suction.</div></div><div><h3>Key findings and limitations</h3><div>A total of 34 studies were included, with a total pooled population of 7193 patients (5552 FANS-UAS and 1641 T-UAS). In comparison to T-UAS use, FANS-UAS use was associated with higher SFRs (by any definition) and lower rates of infections and complications, without any significant difference in operative times. Sensitivity analyses revealed no difference in SFR when comparing FANS-UAS to a T-UAS with suction. Our findings are constrained by variability in study populations, outcome definitions, and intraoperative protocols, alongside poor reporting of device characteristics.</div></div><div><h3>Conclusions and clinical implications</h3><div>In comparison to T-UAS use, FANS-UAS use during RIRS was associated with better stone clearance rates and lower complication rates. Further FANS-UAS optimization may involve changes in sheath sizes and suction parameters.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Pages 752-760"},"PeriodicalIF":6.3000,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European urology focus","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S240545692500255X","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/13 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background and objective

Use of a flexible and navigable suction (FANS) ureteral access sheath (UAS) is increasing for evacuation of fragments during retrograde intrarenal surgery (RIRS) for upper tract stones. We compared the use of FANS-UAS and a traditional UAS (T-UAS) in terms of the stone-free rate (SFR) and adverse events, and captured data on FANS-UAS specifications and intraoperative settings currently being used in practice.

Methods

We performed a systematic review and meta-analysis of comparative and noncomparative studies in the Medline, Embase, and Cochrane databases (January 1, 2000 to March 30, 2025) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Assessing the Methodologic Quality of Systematic Reviews-2 guidelines (CRD42023466330). Preplanned subgroup analyses were performed for variations in the SFR definition and for studies that compared FANS-UAS to a T-UAS with suction.

Key findings and limitations

A total of 34 studies were included, with a total pooled population of 7193 patients (5552 FANS-UAS and 1641 T-UAS). In comparison to T-UAS use, FANS-UAS use was associated with higher SFRs (by any definition) and lower rates of infections and complications, without any significant difference in operative times. Sensitivity analyses revealed no difference in SFR when comparing FANS-UAS to a T-UAS with suction. Our findings are constrained by variability in study populations, outcome definitions, and intraoperative protocols, alongside poor reporting of device characteristics.

Conclusions and clinical implications

In comparison to T-UAS use, FANS-UAS use during RIRS was associated with better stone clearance rates and lower complication rates. Further FANS-UAS optimization may involve changes in sheath sizes and suction parameters.

查看原文本刊更多论文

柔性和可导航的输尿管吸入鞘治疗尿石症：系统回顾和荟萃分析。

背景和目的：在逆行肾内手术（RIRS）治疗上尿路结石时，越来越多的患者使用灵活可导航的抽吸输尿管鞘（UAS）来排出碎片。我们比较了FANS-UAS和传统的UAS （T-UAS）在无结石率（SFR）和不良事件方面的使用，并收集了目前在实践中使用的FANS-UAS规范和术中设置的数据。方法：我们根据系统评价和荟萃分析的首选报告项目以及评估系统评价的方法学质量指南（CRD42023466330），对Medline、Embase和Cochrane数据库（2000年1月1日至2025年3月30日）中的比较和非比较研究进行了系统评价和荟萃分析。对SFR定义的变化以及将FANS-UAS与带吸力的T-UAS进行比较的研究进行了预先计划的亚组分析。主要发现和局限性：共纳入34项研究，共纳入7193例患者（5552例FANS-UAS和1641例T-UAS）。与T-UAS相比，风扇- uas的使用与更高的sfr（根据任何定义）和更低的感染和并发症发生率相关，手术时间没有任何显着差异。敏感性分析显示，当比较风扇- uas与有吸力的T-UAS时，SFR没有差异。我们的研究结果受到研究人群、结果定义、术中方案的可变性以及对器械特性的不良报道的限制。结论和临床意义：与使用T-UAS相比，在RIRS期间使用FANS-UAS与更好的结石清除率和更低的并发症发生率相关。进一步的风扇- uas优化可能涉及改变护套尺寸和吸力参数。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

European urology focus Medicine-Urology

CiteScore

10.40

自引率

3.70%

发文量

274

审稿时长

23 days

期刊介绍： European Urology Focus is a new sister journal to European Urology and an official publication of the European Association of Urology (EAU). EU Focus will publish original articles, opinion piece editorials and topical reviews on a wide range of urological issues such as oncology, functional urology, reconstructive urology, laparoscopy, robotic surgery, endourology, female urology, andrology, paediatric urology and sexual medicine. The editorial team welcome basic and translational research articles in the field of urological diseases. Authors may be solicited by the Editor directly. All submitted manuscripts will be peer-reviewed by a panel of experts before being considered for publication.