A comparative analysis of flexible ureteroscopy with a flexible and navigable suction ureteral access sheath versus mini-percutaneous nephrolithotomy for treatment of upper urinary tract stones: a systematic review and meta-analysis
Abstract
BACKGROUND
The optimal surgical approach for treating upper urinary tract stones remains debated.Historically, percutaneous nephrolithotomy has been regarded as the first-line intervention for renal stones exceeding 2 cm. With the emergence of the flexible and navigable suction ureteral access sheath, however, flexible ureteroscopy appears to have extended its utility to the management of larger renal calculi. In light of this paradigm shift, the present systematic review and meta-analysis aims to compare the efficacy and safety profiles of FANS-assisted flexible ureteroscopy (FANS-fURS) versus mini-percutaneous nephrolithotomy (mPCNL).
METHODS
We conducted a systematic search of electronic databases from 2015 to 2025. Both randomized controlled trials (RCTs) and observational studies comparing FANS-fURS with mPCNL for upper urinary tract stone treatment were included due to limited RCT availability. Primary outcomes included stone-free rates (SFR) at different time points. Secondary outcomes included operative time, hospital stay, hemoglobin decline, and complications.
RESULTS
Ten studies comprising 2,481 patients (1,231 FANS-fURS, 1,250 mPCNL) were included. The results showed that mPCNL had a significantly higher immediate stone-free rate (SFR) compared with FANS-fURS, while the final SFR was comparable between the two groups. Additionally, the FANS-fURS group exhibited a significantly smaller decline in hemoglobin levels, with a weighted mean difference (WMD) ranging…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 2,481 participants or records.
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