Evaluation of the effectiveness and safety of UAS in the treatment of upper urinary tract stones with flexible ureteroscopy lithotripsy: a meta-analysis and systematic review

Abstract

Objective To investigate the effectiveness and safety of ureteral access sheaths (UAS) in flexible ureteroscopic lithotripsy of upper urinary tract stones through a comprehensive systematic review and meta-analysis.Methods We conducted a meta-analysis and systematic review of the UAS in flexible ureteroscopy lithotripsy on April 12, 2023 (PROSPERO ID : CRD42022368459). The main outcomes of the meta-analysis included stone-free rate (SFR), intra and post-operation complications, hospitalization duration, and operation time.Results Twenty-one studies with 11335 patients satisfied the inclusion criteria. The results showed that compared with the UAS group, the non-UAS group had a higher stone-free rate(SFR) (OR = 0.76, 95%CI 0.60–0.95, P = 0.01) and shorter operation time(MD = 11.21, 95% CI 5.66–16.76, P < 0.00001), but no significant difference in postoperative complications(OR = 1.20, 95% CI 0.79–1.82, P = 0.38), intraoperative complications(OR = 1.20, 95%CI 0.85–1.70, P = 0.57), and hospitalization duration (MD = -0.03, 95%CI -0.30-0.24, P = 0.84).Conclusion Our findings indicate that UAS usage results in unfavorable surgical outcomes with no benefit in preventing surgical complications. Therefore, we recommend re-evaluating the usage of UAS as a surgical aid in patients with large stones.