The introduction of a flexible and navigable suction ureteral access sheath (FANS-UAS) has further enhanced retrograde intrarenal surgery (RIRS) by improving kidney stone clearance and reducing operative challenges. However, evidence for their use in the pediatric population remains sparse. Thus, this systematic review focuses on the current evidence on the use of a FANS-UAS during RIRS in children with renal stones. A systematic search of PubMed, Cochrane Library, and Google Scholar was conducted in May 2025 following PRISMA guidelines and PROSPERO registration (CRD420251049140). Studies were included if they reported original data on the use of suction UAS during RIRS in pediatric patients (<18 years). Data on patient demographics, stone characteristics, surgical outcomes, and complications were extracted and analyzed descriptively. Out of 49 screened studies, three met the inclusion criteria, including 74 pediatric patients. A FANS-UAS was used in all cases, with 97% utilizing 10/12 Fr UAS and 91% employing 7.5 Fr endoscopes. The pooled stone-free rate was 99%, with complications limited to minor ureteral injury (6.8%) and Clavien-Dindo I/II events (9.5%). One study showed the superiority of a FANS-UAS over conventional UAS in operative time and initial stone-free rate. However, the evidence was limited by small sample sizes and heterogeneity. RIRS with a FANS-UAS is a safe and effective option for managing pediatric urolithiasis, including large and multiple stones. Nevertheless, current evidence is based on a small number of studies with limited generalizability. Further prospective research is needed to validate these findings, to explore the role of suction and to investigate various UAS endoscope configurations.
Talyshinskii et al. (2026) studied this question.