BACKGROUND: Advances in technology have led to the introduction of the suction ureteral access sheaths (SUASs) in ureteroscopy (URS) and retrograde intrarenal surgery (RIRS), with their clinical benefits becoming widely acknowledged. We aimed to evaluate the efficacy and safety of using SUASs during URS and RIRS. METHODS: A systematic search was conducted in April 2024 across the MEDLINE, Scopus, and Web of Science databases. Our focus was on studies investigating the use of SUASs during URS/RIRS for urinary stones. To compare the stone-free rate (SFR) and perioperative outcomes between URS/RIRS procedures with and without SUASs, standard pairwise meta-analyses were conducted. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were employed utilizing a random-effects model (PROSPERO: CRD42024538956). RESULTS: Seven studies (n=1,746) were identified. The use of SUASs significantly improved immediate SFR compared to non-SUAS group (RR: 1.23; 95% CI: 1.02 to 1.47; P=0.03), while no significant difference was observed in SFR at one month follow-up. The use of SUASs significantly reduced operation time (MD: -7.98 minutes; 95% CI: -13.46 to -2.50; P=0.004) and overall complication rate (RR: 0.49; 95% CI: 0.34 to 0.71; P<0.001). CONCLUSIONS: Our meta-analyses indicate that the use of SUASs during URS/RIRS significantly improves immediate SFR and offers better perioperative outcomes compared to no use of SUASs. To establish SUASs as standard of care, well-designed randomized controlled trials are needed.

Department of Urology 2nd Faculty of Medicine Charles University Prague Czechia

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria

Department of Urology Fuji City General Hospital Shizuoka Japan

Department of Urology Semmelweis University Budapest Hungary

Department of Urology Subaru Health Insurance Society Ota Memorial Hospital Gunma Japan

Department of Urology The Chinese University of Hong Kong Hong Kong China

Department of Urology The Jikei University School of Medicine Tokyo Japan

Department of Urology the University of Texas Southwestern Medical Center Dallas TX USA

Department of Urology Weill Cornell Medical College New York NY USA

Division of Urology Department of Special Surgery The University of Jordan Amman Jordan

Institute for Urology and Reproductive Health Sechenov University Moscow Russia

Karl Landsteiner Institute of Urology and Andrology Vienna Austria

Research Center for Evidence Medicine Urology Department Tabriz University of Medical Sciences Tabriz Iran

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