Small- and large-calibre ureteroscopes: an updated systematic review and meta-analysis.
Francesco Di Bello, Paolo Verri, Alejandra Bravo-Balado et al.
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In 30 seconds
This systematic review and meta-analysis compared perioperative outcomes with small- and large-calibre ureteroscopes. Eight studies were included: four randomised trials and four retrospective studies. For 6.3- versus 7.5-F ureteroscopes, stone-free rates and overall complications were comparable; the risk ratios were 0.99 (95% CI 0.92-1.06) and 1.08 (95% CI 0.77-1.51), respectively. Operative time also showed no clear difference. Sensitivity analyses supported these findings, and no differences in the assessed outcomes were recorded for 7.5- versus >7.5-F scopes.
Key findings
- For 6.3- versus 7.5-F ureteroscopes, the stone-free rate risk ratio was 0.99 (95% CI 0.92-1.06).
- Overall complications with 6.3- versus 7.5-F scopes had a risk ratio of 1.08 (95% CI 0.77-1.51).
- The operative-time standardised mean difference was -14.5 min (95% CI -33.4 to 3.3 min) for 6.3- versus 7.5-F scopes.
- No differences in stone-free rates, complications, or operative time were recorded for 7.5- versus >7.5-F ureteroscopes.
Why it matters
The pooled evidence suggests that smaller-calibre ureteroscopes can achieve perioperative outcomes comparable to larger scopes, without a demonstrated advantage in stone-free rates, complications, or operative time. This helps frame scope calibre as a choice for which comparative outcome evidence remains limited, rather than establishing superiority of either size.
What to keep in mind
The evidence comprised only eight studies, including retrospective studies, and the authors note substantial heterogeneity and residual confounding. They call for well-designed, adequately powered randomised trials.