Flexible and Navigable Suction Ureteral Access Sheaths for the Treatment of Urolithiasis: Systematic Review and Meta-analysis

BACKGROUND AND OBJECTIVE: Use of a flexible and navigable suction (FANS) ureteral access sheath (UAS) is increasing for evacuation of fragments during retrograde intrarenal surgery (RIRS) for upper tract stones. We compared the use of FANS-UAS and a traditional UAS (T-UAS) in terms of the stone-free rate (SFR) and adverse events, and captured data on FANS-UAS specifications and intraoperative settings currently being used in practice. METHODS: We performed a systematic review and meta-analysis of comparative and noncomparative studies in the Medline, Embase, and Cochrane databases (January 1, 2000 to March 30, 2025) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Assessing the Methodologic Quality of Systematic Reviews-2 guidelines (CRD42023466330). Preplanned subgroup analyses were performed for variations in the SFR definition and for studies that compared FANS-UAS to a T-UAS with suction. KEY FINDINGS AND LIMITATIONS: A total of 34 studies were included, with a total pooled population of 7193 patients (5552 FANS-UAS and 1641 T-UAS). In comparison to T-UAS use, FANS-UAS use was associated with higher SFRs (by any definition) and lower rates of infections and complications, without any significant difference in operative times. Sensitivity analyses revealed no difference in SFR when comparing FANS-UAS to a T-UAS with suction. Our findings are constrained by variability in study populations, outcome definitions, and intraoperative protocols, alongside poor reporting of device characteristics. CONCLUSIONS AND CLINICAL IMPLICATIONS: In comparison to T-UAS use, FANS-UAS use during RIRS was associated with better stone clearance rates and lower complication rates. Further FANS-UAS optimization may involve changes in sheath sizes and suction parameters.