The evolution of retrograde intrarenal surgery: a comprehensive meta-analysis of suction-assisted versus conventional techniques against mini-PCNL for 2-3 cm renal stones.
Runze Liu, Yulong Li, Baining Zhang et al.
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In 30 seconds
This systematic review and meta-analysis compared suction-assisted and conventional flexible ureteroscopy (SA-fURS and C-fURS) with mini-percutaneous nephrolithotomy (mPCNL) for 2–3 cm renal stones. It included 18 studies—4 randomised trials and 14 observational studies—with 3,832 patients. mPCNL achieved higher immediate stone-free rates, but low-certainty evidence found no statistically significant difference in final stone-free rates between SA-fURS and mPCNL (OR 0.77, P = 0.11); C-fURS remained significantly less effective. RIRS was associated with lower risks of haemorrhage and transfusion and shorter hospital stays, but longer operations.
Key findings
- mPCNL had higher immediate stone-free rates than RIRS (OR 0.41, low certainty).
- Final stone-free rates did not differ significantly between SA-fURS and mPCNL (OR 0.77, P = 0.11; low certainty); C-fURS was significantly inferior.
- RIRS was associated with lower haemorrhage risk (OR 0.40) and transfusion risk (OR 0.17), both with moderate-certainty evidence.
- RIRS was associated with a shorter hospital stay (MD -2.26 days) but longer operative time (MD 8.81 min); evidence for both outcomes was very low certainty.
Why it matters
For 2–3 cm renal stones, the choice of procedure involves balancing immediate clearance against safety and recovery. These pooled findings suggest suction-assisted ureteroscopy may achieve final stone-free outcomes comparable to mPCNL while reducing bleeding-related risks, although the certainty of some comparisons is low. Distinguishing suction-assisted from conventional ureteroscopy is important because their reported efficacy differed.
What to keep in mind
The evidence combines only 4 randomised trials with 14 observational studies, and certainty was low or very low for several key outcomes, including final stone-free rates and recovery measures.