Safety and efficacy of enhanced recovery after surgery in patients undergoing ureteroscopic lithotripsy: a systematic review and meta-analysis

To evaluate the safety and efficacy of enhanced recovery after surgery (ERAS) in patients undergoing ureteroscopic lithotripsy (URL). PubMed, Embase, the Cochrane Library, Web of Science, CNKI, VIP, Wanfang Data, and SinoMed were searched through 20 November 2025. The primary analysis was restricted to trials reporting an identifiable random-sequence generation method; reports with unclear sequence generation were added in a post hoc sensitivity analysis. Meta-analyses were performed in Review Manager 5.4.1. Twenty-five trials (2,372 participants) were included in the primary analysis, and 15 additional reports were added only in the 40-trial sensitivity analysis. ERAS shortened postoperative hospital stay (12 trials; MD − 1.59 days, 95% CI − 1.87 to − 1.30; I²=94%) and total hospital stay (7 trials; MD − 1.94 days, 95% CI − 2.30 to − 1.59; I²=84%) and reduced study-reported overall postoperative complications (22 trials; RR 0.29, 95% CI 0.22–0.38; I²=0%). ERAS also accelerated recovery milestones, shortened catheter duration, reduced hospitalization cost, and improved patient satisfaction. Effect directions were unchanged in the sensitivity analysis. Most continuous outcomes showed substantial or considerable heterogeneity. The stone-free-rate result was borderline (3 trials; RR 1.10, 95% CI 1.00–1.20; P = 0.039). ERAS may improve short-term recovery and reduce study-reported overall complications after URL. The magnitude and certainty of these associations are limited by substantial heterogeneity, incomplete allocation-concealment reporting, heterogeneous complication definitions, and single-country evidence. The stone-free-rate finding remains uncertain.