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

作者：Baian Wei, Zhenlang Guo, Y. Yu, Shu Gan, Zhaohui Wang, Zunguang Bai, Xinfeng Guo, Junwei He · 发表于：International Journal of Surgery · 年份：2025 · DOI：10.1097/js9.0000000000003697 · 被引用次数：4 · 研究领域：Kidney Stones and Urolithiasis Treatments、Urinary Tract Infections Management、Ureteral procedures and complications

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 (FANS) 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 2481 patients (1231 FANS-fURS, 1250 mPCNL) were included. The results showed that mPCNL had a significantly higher immediate 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 from -4.87 to ...