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PubMed · 42714596

Suction-assisted ureteroscopy compared with traditional ureteroscopy for renal stones ≤ 2 cm: a systematic review, Bayesian network meta-analysis and meta-regression.

David E Hinojosa-Gonzalez·Andres Gutierrez-Gamez·Mauricio Torres-Martinez·Alejandro Calvillo-Ramirez·Gal Saffati-Grunhaus·Aidan Boyne·Amelia G Oppenheimer·Payton Coady·Beatriz S Hernandez·Richard Edward Link·Jeremy R Slawin·Wesley A Mayer
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Abstract

INTRODUCTION AND OBJECTIVE: Suction-enhanced flexible ureteroscopy (URS) aims to improve stone clearance and reduce complications. We performed a Bayesian network meta-analysis to compare the efficacy and safety of flexible aspiration navigable sheaths (FANS) and direct in-scope suction (DISS) for renal calculi ≤ 2 cm. METHODS: A systematic search of PubMed, MEDLINE, Scopus, Web of Science, and Google Scholar was conducted through June 2026. Comparative studies of FANS, DISS, or conventional access sheaths for renal stones ≤ 2 cm were included. The primary outcome was 30-day stone-free rate (SFR). Secondary outcomes included operative time, fever, sepsis, and complications. A Bayesian random-effects network meta-analysis synthesized direct and indirect evidence. RESULTS: Seventeen studies including 3,657 patients (1,677 FANS, 56 DISS, 1,924 control) were included. FANS showed higher SFR (OR 2.5, 95% CrI 2.0-3.1), while grouped DISS had a similar but less precise effect (OR 3.1, 95% CrI 1.0-8.8). Calyxo V2 had the highest SFR (OR 5.4, 95% CrI 1.0-29.0), whereas PUSEN showed no significant difference (OR 1.6, 95% CrI 0.41-6.3). FANS reduced postoperative fever and complications. FANS also showed lower odds of postoperative sepsis (OR 0.40, 95% CrI 0.12-0.97). CONCLUSIONS: Suction-assisted ureteroscopy improves SFR for renal calculi ≤ 2 cm. FANS was associated with shorter operative time, fever, and complications. DISS systems show promising but limited results, with performance differing by technology configuration. Larger prospective trials are needed.

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HumansUreteroscopyKidney CalculiSuctionBayes TheoremEndourologyKidney stonesNephrolithiasisNetwork meta-analysisSuction-assisted ureteroscopyJournal ArticleNetwork Meta-AnalysisSystematic ReviewComparative Study

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David E Hinojosa-Gonzalez, Andres Gutierrez-Gamez, Mauricio Torres-Martinez, Alejandro Calvillo-Ramirez, Gal Saffati-Grunhaus, Aidan Boyne, Amelia G Oppenheimer, Payton Coady, Beatriz S Hernandez, Richard Edward Link, Jeremy R Slawin, Wesley A Mayer. 2026-09-09. Suction-assisted ureteroscopy compared with traditional ureteroscopy for renal stones ≤ 2 cm: a systematic review, Bayesian network meta-analysis and meta-regression.. https://doi.org/10.1007/s00345-026-06759-6

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Bayes Theorem subjectComparative Study subjectHumans subjectJournal Article subjectKidney Calculi subjectNetwork Meta-Analysis subjectSystematic reviews study

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