SynthesisInternational urology and nephrology2026
The evolution of retrograde intrarenal surgery: a comprehensive meta-analysis of suction-assisted versus conventional techniques against mini-PCNL for 2-3 cm renal stones.
Synthesis in International urology and nephrology, 2026. 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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7 authors.
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Abstract
objectiveTo evaluate the technological evolution of Retrograde Intrarenal Surgery (RIRS) by comprehensively comparing real-world and randomized outcomes of suction-assisted (SA-fURS) and conventional (C-fURS) techniques against Mini-Percutaneous Nephrolithotomy (mPCNL) for 2-3 cm renal stones.
methodsA systematic search was performed in PubMed, Embase, Web of Science, Cochrane Library, and Scopus up to September 1, 2025. Randomized controlled trials (RCTs) and observational studies were included. Primary outcomes were immediate and final stone-free rates (SFR). Secondary outcomes included complications, operative time, and hospital stay. The certainty of evidence was assessed using the GRADE approach.
resultsEighteen studies (4 RCTs, 14 non-RCTs) involving 3,832 patients were included. mPCNL provided higher immediate SFR (OR 0.41, low certainty). However, low-certainty evidence suggests the difference in final SFR between SA-fURS and mPCNL did not reach statistical significance (OR 0.77, P = 0.11), whereas C-fURS remained significantly inferior. RIRS demonstrated a superior safety profile with significantly lower risks of hemorrhage (OR 0.40, moderate certainty) and blood transfusion (OR 0.17, moderate certainty), and a shorter hospital stay (MD -2.26 days, very low certainty), despite longer operative times (MD 8.81 min, Very Low Certainty).
conclusionWhile mPCNL provides superior immediate clearance, low-certainty evidence indicates no statistically significant difference in final stone-free rates between SA-fURS and mPCNL. Furthermore, SA-fURS demonstrates a favorable safety profile and faster recovery. Crucially, C-fURS remains significantly inferior in efficacy. These comprehensive findings validate recent randomized trials in a broader clinical context, establishing SA-fURS as a highly effective, minimally invasive alternative to mPCNL, whereas C-fURS should be considered a suboptimal choice for this stone burden.
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