Suction versus traditional ureteral access sheaths in retrograde intrarenal surgery: an updated systematic review and meta-analysis of stone-free rates and complications.
José Arnaldo Shiomi da Cruz, Bruno D Terada, Felipe G A Gonçalves et al.
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In 30 seconds
This updated systematic review and meta-analysis compared suction with traditional ureteral access sheaths during retrograde intrarenal surgery in adults. It included 29 comparative studies, four randomized, involving 5,604 patients. Suction sheaths were associated with fewer residual fragments at early assessment (RR 0.49; 95% CI 0.42-0.58) and late assessment (RR 0.53; 0.45-0.63), as well as less fever and sepsis. Operative time did not differ. Certainty was moderate for stone clearance and fever, but low or very low for most other outcomes.
Key findings
- Residual fragments were less frequent with suction sheaths at early assessment (RR 0.49; 95% CI 0.42-0.58) and late assessment (RR 0.53; 0.45-0.63).
- Suction sheaths were associated with lower rates of fever (RR 0.43; 0.34-0.53) and sepsis (RR 0.47; 0.31-0.72).
- Operative time did not differ; hospital stay was 0.32 days shorter, but this result was not robust.
- Late stone-clearance benefit was greater with flexible-tip than fixed-tip sheaths (RR 0.47 vs RR 0.72; p = 0.03), in a post hoc analysis.
Why it matters
Stone clearance and infectious complications are relevant outcomes of retrograde intrarenal surgery. This synthesis suggests suction sheaths may improve clearance and reduce fever, while also showing that evidence is less certain for sepsis and severe complications. The findings help frame the potential benefits alongside unresolved questions about serious outcomes and whether sheath-tip design modifies effectiveness.
What to keep in mind
Only four included studies were randomized, and certainty was low or very low for most outcomes beyond stone clearance and fever. The flexible-tip comparison was post hoc; septic shock events were rare.