A comparative analysis of tip-bendable suction ureteral access sheath versus traditional sheath in retrograde intrarenal stone surgery: a systematic review and meta-analysis of comparative studies.

Objective: This systematic review and meta-analysis seeks to evaluate the efficacy and safety of tip-bendable suction ureteral access sheaths (TBS-UAS) compared to traditional ureteral access sheaths (UAS) in retrograde intrarenal stone surgery (RIRS).

Methods: A thorough literature search was performed across multiple databases, including MEDLINE (via PubMed), Cochrane Library, and Embase (via Ovid) for studies published until January 2025. We included randomized controlled trials (RCTs) and observational studies that reporting data on stone-free rates (SFRs), surgical duration, postoperative length of stay, and complication rates. Data were extracted and analyzed using random or fixed effects models to compute pooled relative risks (RRs) and mean differences (MD), along with their corresponding 95% confidence intervals (CIs).

Results: Eight studies involving a total of 1,981 patients were included in the analysis. The TBS-UAS group exhibited a statistically significant enhancement in immediate SFR (RR = 1.57, 95% CI: 1.18-2.09) and SFR at one month postoperatively (RR = 1.24, 95% CI: 1.05-1.46) compared to the traditional UAS group. Additionally, the TBS-UAS was associated with a lower overall complication rate (RR = 0.41, 95% CI: 0.29-0.56) and a reduced incidence of fever (RR = 0.37, 95% CI: 0.25-0.53). No significant differences were found regarding surgical duration, postoperative length of stay, intraoperative bleeding, or mucosal injury between the two groups.

Conclusion: The results indicate that TBS-UAS may provide notable advantages over conventional sheaths in RIRS, particularly in improving SFRs and reducing both overall and infectious complication rates. Further large-scale RCTs are needed to confirm these findings and assess long-term outcomes.