{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T21:13:47Z","timestamp":1793913227283,"version":"4.8.0"},"reference-count":24,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Endourology"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>We aimed to evaluate the efficacy, safety, and cost-effectiveness of suction-assisted retrograde intrarenal surgery (SA-RIRS) compared with conventional retrograde intrarenal surgery (RIRS) and to compare outcomes between suction catheters and suction sheaths in the management of upper urinary tract stones \u226430 mm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed, Embase, Cochrane Library, and Web of Science were searched to September 2025. Eligible RCTs compared SA-RIRS (catheter or sheath) with conventional RIRS in adults. Primary outcomes were stone-free rate (SFR), total complications, and operative time; secondary outcomes included hospital stay, reoperation rate, stone retropulsion, basket use, and laser time. Risk of bias (RoB) was assessed using the Cochrane RoB 2.0, and evidence certainty was rated with the Grading of Recommendations, Assessment, Development, and Evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Six RCTs involving 843 patients (SA-RIRS: 420; conventional RIRS: 423) were included. SA-RIRS significantly improved SFR (odds ratio [OR] = 4.00, 95% confidence interval [CI]: [2.92, 5.48],\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001) and reduced total complications (OR = 0.40, 95% CI: [0.17, 0.97]), stone retropulsion (OR = 0.26,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.03), and basket use (OR = 0.01,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001). Subgroup analysis demonstrated that both suction sheaths (OR = 4.46) and suction catheters (OR = 2.64) significantly improved SFR compared with conventional RIRS, with sheaths showing greater complication reduction (OR = 0.27\n                      <jats:italic toggle=\"yes\">vs<\/jats:italic>\n                      0.77). No significant differences were observed in operative time, hospital stay, or reoperation rate. Evidence certainty was high for all outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>SA-RIRS provides superior stone clearance and safety compared with conventional RIRS. Although sheath-based systems offer the highest SFRs and complication reductions, suction catheters also significantly improve clearance and remain a cost-effective option for impacted ureteral stones. Findings support integrating SA-RIRS into routine endourological practice, with device selection guided by stone location and resource availability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration PROSPERO:<\/jats:title>\n                    <jats:p>CRD420251149743.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08927790261450680","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T05:25:23Z","timestamp":1779341123000},"page":"964-975","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Enhanced Outcomes with Suction-Assisted Retrograde Intrarenal Stone Surgery for Urolithiasis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9139-6160","authenticated-orcid":false,"given":"Yulong","family":"Li","sequence":"first","affiliation":[{"name":"Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6559-6155","authenticated-orcid":false,"given":"Huachen","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongbao","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huantao","family":"Zong","sequence":"additional","affiliation":[{"name":"Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.13828"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2012.03.052"},{"key":"e_1_3_3_4_1","volume-title":"EAU Guidelines on Urolithiasis","author":"Skolarikos A","year":"2024","unstructured":"3.Skolarikos A, , Neisius A, , Pet\u0159\u00edk A, , Somani B, , Thomas K, , Gambaro G. EAU Guidelines on Urolithiasis. European Association of Urology; 2024."},{"key":"e_1_3_3_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrurol.2012.204"},{"key":"e_1_3_3_6_1","doi-asserted-by":"publisher","DOI":"10.1089\/end.2020.1133"},{"key":"e_1_3_3_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2015.11.009"},{"key":"e_1_3_3_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/JS9.0000000000002202"},{"key":"e_1_3_3_9_1","doi-asserted-by":"publisher","DOI":"10.1089\/end.2024.0602"},{"key":"e_1_3_3_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00240-025-01769-2"},{"key":"e_1_3_3_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-025-05520-9"},{"key":"e_1_3_3_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2024.102724"},{"key":"e_1_3_3_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-018-2049-9"},{"key":"e_1_3_3_14_1","first-page":"S2405","article-title":"Flexible and Navigable Suction Ureteral Access Sheaths for the Treatment of Urolithiasis: Systematic Review and Meta-analysis","author":"Uy M","year":"2025","unstructured":"13.Uy M, , Moryousef J, , Wang L, et al. Flexible and Navigable Suction Ureteral Access Sheaths for the Treatment of Urolithiasis: Systematic Review and Meta-analysis. Eur Urol Focus 2025:S2405.","journal-title":"Eur Urol Focus"},{"key":"e_1_3_3_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-024-04280-6"},{"key":"e_1_3_3_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_3_3_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/bco2.408"},{"key":"e_1_3_3_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_3_3_19_1","unstructured":"18.Higgins JPT Thomas J Chandler J Cumpston M Li T Page MJ Welch VA.(editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.4 (updated August 2023. Cochrane 2023. 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