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Meta-Analysis
. 2025 May 19;25(1):127.
doi: 10.1186/s12894-025-01817-4.

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

Qiang Liu  1 , Ting Zeng  2 , Shuxia Zhu  3
Affiliations
Meta-Analysis

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

Qiang Liu et al. BMC Urol. .

Abstract

Background: 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).

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: Flexible ureteroscopy; Meta-analysis; Postoperative complications; Stone-free rate; Suction ureteral access sheath.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval for this meta-analysis was granted by the Ethics Committee of Chengdu Second People’s Hospital. The requirement for informed consent was waived as the study exclusively analyzed aggregated, anonymized data from previously published studies. This research adhered to the principles outlined in the Declaration of Helsinki ( https://www.wma.net/policies-post/wma-declaration-of-helsinki/ ). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flow chart outlining the systematic search strategy and study selection process
Fig. 2
Fig. 2
Forest plot displaying the effect of FANS-UAS versus T-UAS on stone-free rate at postoperative day 1
Fig. 3
Fig. 3
Forest plot displaying the effect of FANS-UAS versus T-UAS on stone-free rate at postoperative day 30
Fig. 4
Fig. 4
Forest plot displaying the effect of FANS-UAS versus T-UAS on operative time
Fig. 5
Fig. 5
Forest plot displaying the effect of FANS-UAS versus T-UAS on length of hospital stay
Fig. 6
Fig. 6
Forest plot displaying the effect of FANS-UAS versus T-UAS on complication rates
Fig. 7
Fig. 7
Forest plot displaying the effect of FANS-UAS versus T-UAS on postoperative fever
See this image and copyright information in PMC

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