Suction versus traditional ureteral access sheaths in retrograde intrarenal surgery: an updated systematic review and meta-analysis of stone-free rates and complications
In brief
Suction sheaths halve residual fragments and cut fever after kidney-stone surgery
Across 29 studies involving 5,604 adults, suction sheaths were linked to about half as many residual stone fragments and 57% fewer fevers than traditional sheaths; sepsis was also less common. Most evidence was low certainty, and septic shock was rare, so the findings do not establish a shock benefit or confirm whether flexible-tip sheaths work better.
- Journal
- World journal of urology (Q1)
- Published
- 5 November 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- José Arnaldo Shiomi da Cruz, Bruno D Terada, Felipe G A Gonçalves, Leonardo O D da Silva, Artur S Almeida, Breno C Porto, et al.
- PMID
- 42986335
- DOI
- 10.1007/s00345-026-06873-5
Why clinicians should know about it
- Picked for Urology (paper of the day, 6 November 2026): Compares suction sheaths for stone clearance and RIRS complications
Abstract
PURPOSE: Suction ureteral access sheaths (S-UAS), fixed-tip or flexible and navigable (FANS), are proposed to improve stone clearance and reduce infections in retrograde intrarenal surgery (RIRS); we updated our 2025 meta-analysis and asked whether tip design changes the effect. METHODS: Five databases were searched from inception to March 2026 for comparative studies of S-UAS versus traditional sheaths (T-UAS) in adult RIRS (PROSPERO CRD420251164154). Outcomes were residual fragments at early (up to 3 weeks) and late (4 weeks or later) assessment, fever, sepsis, septic shock, severe complications, operative time and hospital stay, analyzed with random-effects models, subgroups by design and tip design, small-study tests and GRADE. RESULTS: Twenty-nine studies (four randomized; 5,604 patients) were included. S-UAS reduced residual fragments at early (RR 0.49; 95% CI 0.42-0.58; 22 studies) and late assessment (RR 0.53; 0.45-0.63; 23 studies), fever (RR 0.43; 0.34-0.53), sepsis (RR 0.47; 0.31-0.72) and severe complications (RR 0.48; 0.33-0.69). Septic shock was rare (4 versus 12 events; RR 0.41; 0.15-1.15). Operative time did not differ; hospital stay was 0.32 days shorter, but not robustly so. Post hoc, the late benefit was larger with tip-flexible (RR 0.47) than with fixed-tip sheaths (RR 0.72; p = 0.03). Certainty was moderate for stone clearance and fever (low for early clearance in non-randomized studies), otherwise low or very low. CONCLUSION: S-UAS probably improve stone clearance and reduce fever and may reduce sepsis; the evidence on severe complications is very uncertain. The effect on septic shock and a possible advantage of the flexible tip need randomized confirmation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.