SynthesisBMC urology2025
Effectiveness and safety of suction-assisted versus traditional access sheaths in minimally invasive percutaneous nephrolithotomy: a meta-analysis of 10 randomized trials.
Synthesis in BMC urology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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4 authors.
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Abstract
objectiveTo systematically evaluate the effectiveness and safety of suction-assisted sheaths (SAS) compared to traditional access sheaths (TAS) in minimally invasive percutaneous nephrolithotomy (MPCNL) for renal calculi-addressing key limitations of MPCNL such as compromised irrigation outflow, intraoperative elevation of intrarenal pressure (IRP), and the associated risk of infectious complications.
methodsThis PRISMA-compliant meta-analysis (PROSPERO-registered) included 10 randomized controlled trials (RCTs; n = 1,540) identified through comprehensive searches of PubMed, Embase, Web of Science, and the Cochrane Library from database inception to May 2025. Pooled outcomes were calculated using random- or fixed-effects models, with subgroup analyses based on lithotripsy modality (laser vs. non-laser) and stone type (staghorn vs. non-staghorn). Study quality was assessed using the Cochrane Risk of Bias Tool, and evidence certainty was graded via GRADE.
resultsCompared to TAS, the use of SAS was associated with a significantly higher immediate stone-free rate (SFR; OR 2.29, 95% CI 1.76-3.00) and 3-month SFR (OR 2.72, 95% CI 1.42-5.22), with a greater benefit observed in non-staghorn stones. SAS was also associated with a mean reduction in intrarenal pressure (IRP) of 8.25 mmHg (95% CI - 9.44 to - 7.06), with a more pronounced effect in non-laser procedures. A significant reduction in operative time was observed (MD -13.86 min, 95% CI - 26.43 to - 1.30), although this finding should be interpreted with caution due to substantial heterogeneity (I² = 98%). Regarding safety, SAS was associated with lower rates of postoperative fever (OR 0.40), transfusion (OR 0.43), second surgeries (OR 0.63), and auxiliary procedures (OR 0.38). No significant differences were found for UTI, hospitalization duration, or hemoglobin loss.
conclusionsThis meta-analysis suggests that the use of a suction-assisted sheath in MPCNL is associated with higher stone-free rates, shorter operative times, reduced intrarenal pressure, and a lower incidence of certain postoperative complications, including fever and transfusion requirements. The findings indicate a favorable safety and efficacy profile, suggesting that SAS is a valuable modification for optimizing procedural outcomes.
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