Background: Upper urinary tract stones are common diseases in urology. Ureteroscopic lithotripsy is one of the main methods for the treatment of upper urinary tract stones. With the rise of flexible urinary tract examination (F-UAS), it makes surgery safer and more effective. This study aims to compare the safety and effectiveness of flexible ureteral access sheath and traditional ureteral access sheath when used with ureteroscopic lithotripsy for treating upper urinary tract stones. Methods: A systematic search was conducted on PubMed, Embase, cochrane library, scopus, and web of science databases for studies that evaluated the use of F-UAS in treating upper urinary tract stones. The outcome measures assessed in this study included operation time, immediate stone-free rate (SFR), 1-month postoperative follow-up SFR, postoperative complication rate, postoperative fever rate, and hospital stay after surgery. Results: This study included 9 studies involving 1769 patients, with 907 in the experimental group and 862 in the control group. The meta-analysis revealed no significant difference in operation time between the experimental and control groups (MD = 4.73, 95% confidence interval CI: −2.41 to 11.86, P = .19). The experimental group demonstrated higher immediate SFR (OR = 3.84, 95% CI: 1.56–9.42, P = .003) and postoperative follow-up SFR (OR = 2.60, 95% CI: 1.61–4.20, P < .0001). Additionally, the incidence of postoperative complications was lower in the experimental group (OR = 0.47, 95% CI: 0.30–0.74, P = .001), as was the incidence of fever (OR = 0.27, 95% CI: 0.16–0.45, P < .00001). Furthermore, the postoperative hospital stay was shorter for the experimental group than the control group (MD = −0.09, 95% CI: −0.16 to 0.01, P = .02). No significant differences were observed in stone size (MD = 0.20, 95% CI: −0.13 to 0.53, P = .24) and age between the 2 groups (MD = 0.30, 95% CI: −0.88 to 1.47, P = .62). Conclusion: Compared to traditional ureteral access sheath, applying negative pressure suction with F-UAS for treating upper urinary tract calculi has enhanced stone clearance rates, expedited patient discharge, and decreased postoperative complications. Consequently, F-UAS may represent a superior option for retrograde internal surgery in clinical practice.
Duan et al. (Fri,) studied this question.