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 Article Swipe
Baian Wei
,
Zhenlang Guo
,
Y. Yu
,
Shu Gan
,
Zhaohui Wang
,
Zunguang Bai
,
Xinfeng Guo
,
Junwei He
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1097/js9.0000000000003697
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1097/js9.0000000000003697
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 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 2,481 patients (1,231 FANS-fURS, 1,250 mPCNL) were included. The results showed that mPCNL had a significantly higher immediate stone-free rate (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 g/dL to −2.63 g/dL and a significantly shorter hospital stay, with a WMD ranging from −2.50 days to −1.09 days. Operative time showed mixed results across the included studies, with a pooled mean difference of 4.5 minutes (95% CI: − 4.6 to 13.7). Complication rates were generally lower in the FANS-fURS group, particularly for major complications (Clavien-Dindo ≥III). Conclusions: FANS-fURS appears to offer comparable stone-free rates with reduced complications compared to mPCNL, making it a viable alternative for treating upper urinary tract stones. However, the evidence is primarily from observational studies, and high-quality RCTs are needed to confirm these findings.
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https://doi.org/10.1097/js9.0000000000003697Digital Object Identifier
- Title
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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-analysisWork title
- Type
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reviewOpenAlex work type
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enPrimary language
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2025Year of publication
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2025-10-15Full publication date if available
- Authors
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Baian Wei, Zhenlang Guo, Y. Yu, Shu Gan, Zhaohui Wang, Zunguang Bai, Xinfeng Guo, Junwei HeList of authors in order
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https://doi.org/10.1097/js9.0000000000003697Publisher landing page
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YesWhether a free full text is available
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diamondOpen access status per OpenAlex
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https://doi.org/10.1097/js9.0000000000003697Direct OA link when available
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| abstract_inverted_index.final | 174 |
| abstract_inverted_index.group | 185 |
| abstract_inverted_index.light | 57 |
| abstract_inverted_index.lower | 250 |
| abstract_inverted_index.mPCNL | 109, 160 |
| abstract_inverted_index.major | 257 |
| abstract_inverted_index.mixed | 226 |
| abstract_inverted_index.offer | 265 |
| abstract_inverted_index.rates | 127, 247, 268 |
| abstract_inverted_index.renal | 23, 54 |
| abstract_inverted_index.stay, | 139, 212 |
| abstract_inverted_index.stone | 114 |
| abstract_inverted_index.these | 301 |
| abstract_inverted_index.time, | 137 |
| abstract_inverted_index.tract | 9, 113, 284 |
| abstract_inverted_index.upper | 7, 111, 282 |
| abstract_inverted_index.while | 172 |
| abstract_inverted_index.(1,231 | 150 |
| abstract_inverted_index.(RCTs) | 102 |
| abstract_inverted_index.13.7). | 245 |
| abstract_inverted_index.access | 38 |
| abstract_inverted_index.across | 228 |
| abstract_inverted_index.group, | 254 |
| abstract_inverted_index.higher | 164 |
| abstract_inverted_index.larger | 53 |
| abstract_inverted_index.mPCNL) | 153 |
| abstract_inverted_index.mPCNL, | 274 |
| abstract_inverted_index.making | 275 |
| abstract_inverted_index.needed | 298 |
| abstract_inverted_index.pooled | 234 |
| abstract_inverted_index.review | 65 |
| abstract_inverted_index.safety | 74 |
| abstract_inverted_index.search | 90 |
| abstract_inverted_index.shift, | 61 |
| abstract_inverted_index.showed | 158, 225 |
| abstract_inverted_index.stones | 10, 24 |
| abstract_inverted_index.trials | 101 |
| abstract_inverted_index.versus | 81 |
| abstract_inverted_index.viable | 278 |
| abstract_inverted_index.Primary | 123 |
| abstract_inverted_index.appears | 43, 263 |
| abstract_inverted_index.between | 178 |
| abstract_inverted_index.compare | 70 |
| abstract_inverted_index.confirm | 300 |
| abstract_inverted_index.decline | 190 |
| abstract_inverted_index.groups. | 181 |
| abstract_inverted_index.levels, | 193 |
| abstract_inverted_index.limited | 120 |
| abstract_inverted_index.minutes | 239 |
| abstract_inverted_index.optimal | 2 |
| abstract_inverted_index.points. | 132 |
| abstract_inverted_index.present | 63 |
| abstract_inverted_index.ranging | 200, 216 |
| abstract_inverted_index.reduced | 270 |
| abstract_inverted_index.remains | 11 |
| abstract_inverted_index.results | 157, 227 |
| abstract_inverted_index.sheath, | 39 |
| abstract_inverted_index.shorter | 210 |
| abstract_inverted_index.smaller | 189 |
| abstract_inverted_index.stones. | 285 |
| abstract_inverted_index.studies | 105, 146 |
| abstract_inverted_index.suction | 36 |
| abstract_inverted_index.urinary | 8, 112, 283 |
| abstract_inverted_index.utility | 48 |
| abstract_inverted_index.−1.09 | 221 |
| abstract_inverted_index.−2.50 | 218 |
| abstract_inverted_index.−2.63 | 205 |
| abstract_inverted_index.−4.87 | 202 |
| abstract_inverted_index.(mPCNL). | 84 |
| abstract_inverted_index.However, | 286 |
| abstract_inverted_index.Methods: | 85 |
| abstract_inverted_index.Results: | 144 |
| abstract_inverted_index.approach | 4 |
| abstract_inverted_index.calculi. | 55 |
| abstract_inverted_index.compared | 169, 272 |
| abstract_inverted_index.decline, | 141 |
| abstract_inverted_index.efficacy | 72 |
| abstract_inverted_index.evidence | 288 |
| abstract_inverted_index.extended | 46 |
| abstract_inverted_index.flexible | 33, 41, 78 |
| abstract_inverted_index.hospital | 138, 211 |
| abstract_inverted_index.however, | 40 |
| abstract_inverted_index.included | 117, 125, 135, 230 |
| abstract_inverted_index.outcomes | 124, 134 |
| abstract_inverted_index.paradigm | 60 |
| abstract_inverted_index.patients | 149 |
| abstract_inverted_index.profiles | 75 |
| abstract_inverted_index.regarded | 17 |
| abstract_inverted_index.studies, | 231, 293 |
| abstract_inverted_index.surgical | 3 |
| abstract_inverted_index.treating | 6, 281 |
| abstract_inverted_index.ureteral | 37 |
| abstract_inverted_index.weighted | 196 |
| abstract_inverted_index.≥III). | 260 |
| abstract_inverted_index.FANS-fURS | 107, 184, 253, 262 |
| abstract_inverted_index.Operative | 223 |
| abstract_inverted_index.Secondary | 133 |
| abstract_inverted_index.comparing | 106 |
| abstract_inverted_index.conducted | 87 |
| abstract_inverted_index.databases | 93 |
| abstract_inverted_index.different | 130 |
| abstract_inverted_index.emergence | 30 |
| abstract_inverted_index.exceeding | 25 |
| abstract_inverted_index.exhibited | 186 |
| abstract_inverted_index.findings. | 302 |
| abstract_inverted_index.generally | 249 |
| abstract_inverted_index.immediate | 165 |
| abstract_inverted_index.included. | 155 |
| abstract_inverted_index.navigable | 35 |
| abstract_inverted_index.operative | 136 |
| abstract_inverted_index.primarily | 290 |
| abstract_inverted_index.treatment | 115 |
| abstract_inverted_index.FANS-fURS, | 151, 171 |
| abstract_inverted_index.comparable | 177, 266 |
| abstract_inverted_index.comprising | 147 |
| abstract_inverted_index.controlled | 100 |
| abstract_inverted_index.difference | 198, 236 |
| abstract_inverted_index.electronic | 92 |
| abstract_inverted_index.first-line | 20 |
| abstract_inverted_index.hemoglobin | 140, 192 |
| abstract_inverted_index.management | 51 |
| abstract_inverted_index.randomized | 99 |
| abstract_inverted_index.stone-free | 126, 166, 267 |
| abstract_inverted_index.systematic | 64, 89 |
| abstract_inverted_index.(FANS-fURS) | 80 |
| abstract_inverted_index.Background: | 0 |
| abstract_inverted_index.alternative | 279 |
| abstract_inverted_index.Complication | 246 |
| abstract_inverted_index.Conclusions: | 261 |
| abstract_inverted_index.high-quality | 295 |
| abstract_inverted_index.intervention | 21 |
| abstract_inverted_index.particularly | 255 |
| abstract_inverted_index.percutaneous | 13 |
| abstract_inverted_index.ureteroscopy | 42, 79 |
| abstract_inverted_index.Additionally, | 182 |
| abstract_inverted_index.FANS-assisted | 77 |
| abstract_inverted_index.availability. | 122 |
| abstract_inverted_index.complications | 258, 271 |
| abstract_inverted_index.meta-analysis | 67 |
| abstract_inverted_index.observational | 104, 292 |
| abstract_inverted_index.significantly | 163, 188, 209 |
| abstract_inverted_index.(Clavien-Dindo | 259 |
| abstract_inverted_index.complications. | 143 |
| abstract_inverted_index.nephrolithotomy | 14, 83 |
| abstract_inverted_index.mini-percutaneous | 82 |
| abstract_inverted_index.debated.Historically, | 12 |
| cited_by_percentile_year | |
| countries_distinct_count | 1 |
| institutions_distinct_count | 8 |
| citation_normalized_percentile.value | 0.65956665 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |