{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T06:07:18Z","timestamp":1788847638215,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To conduct a meta\u2010analysis comparing the efficacy and perioperative outcomes of contemporary flexible and navigable suction access sheath\u2010assisted retrograde intrarenal surgery (FANS\u2010RIRS) against percutaneous nephrolithotomy (PCNL) for the management of large upper urinary tract stones, as despite technological advances in RIRS such as high\u2010powered lasers and FANS that have substantially enhanced its performance, current guidelines continue to recommend\u2009PCNL as first\u2010line treatment for renal stones &gt;2cm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>MEDLINE, Embase, and the Cochrane Library were searched for studies performing direct comparisons of FANS\u2010RIRS against PCNL in adult patients until September 2025. Primary outcomes included stone\u2010free rates (SFRs) and need for ancillary procedures. Secondary outcomes included operative time, length of postoperative hospitalisation, and postoperative complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 10 studies (three randomised control trials, seven retrospective cohort studies) comprising 2347 patients were included; preoperative stone sizes were predominantly 2\u20133\u2009cm. All PCNL procedures in the studies included were performed as mini\u2010PCNL. The SFRs for FANS\u2010RIRS were comparable with mini\u2010PCNL across all stone sizes (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.70\u20131.17) and stones \u22652\u2009cm (OR 0.80, 95% CI 0.60\u20131.08), with low heterogeneity. Ancillary procedures rates were similar (OR 1.22, 95% CI 0.61\u20132.44). FANS\u2010RIRS was associated with significantly fewer overall complications, specifically smaller haemoglobin decline, need for transfusion, and shorter hospital stay. However, mini\u2010PCNL demonstrated shorter operative times for stones \u22652\u2009cm. Urosepsis rates were low and similar between both groups. Limitations include predominance of Asian studies, variability of practice, and inclusion of non\u2010randomised studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Contemporary FANS\u2010RIRS achieves SFRs comparable to mini\u2010PCNL even for 2\u20133\u2009cm stones, while offering superior safety profiles and shorter hospitalisation; this supports FANS\u2010RIRS as a viable primary treatment in selected patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70393","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T01:12:06Z","timestamp":1785373926000},"page":"576-588","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Retrograde intrarenal surgery with flexible and navigable suction access sheaths vs mini\u2010percutaneous nephrolithotomy for large upper urinary tract stones: a\u00a0systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"138","author":[{"given":"Han Jie","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Urology Singapore General Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1715-7197","authenticated-orcid":false,"given":"Clyve","family":"Yaow","sequence":"additional","affiliation":[{"name":"Department of Urology Singapore General Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan Ian Houe","family":"Chong","sequence":"additional","affiliation":[{"name":"Department of Urology Singapore General Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonam","family":"Kelzang","sequence":"additional","affiliation":[{"name":"Department of Urology Singapore General Hospital  Singapore 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