- Design
- Systematic review and Bayesian network meta-analysis of 17 studies
- Population
- 3,657 patients with renal stones ≤2 cm
- Primary outcome
- 30-day stone-free rate
- Effect
- FANS stone-free OR 2.5 (2.0–3.1); sepsis OR 0.40 (0.12–0.97)
A Bayesian network meta-analysis in the World Journal of Urology (9 September) combined 17 comparative studies of 3,657 patients with kidney stones of 2 cm or less, comparing flexible aspiration navigable sheaths (FANS), direct in-scope suction and conventional access sheaths.
FANS was associated with higher 30-day stone-free rates (OR 2.5, 95% credible interval 2.0–3.1), less postoperative fever and complications, and lower odds of sepsis (OR 0.40, 0.12–0.97). In-scope suction showed a similar but much less certain effect, based on only 56 patients.
For nephrologists, the relevant point is infection: suction lowers intrarenal pressure, and postoperative sepsis is a leading cause of harm after ureteroscopy, especially in patients with CKD or a single kidney. Most included studies were observational, so the size of the effect is uncertain.
- Discuss suction ureteroscopy with urology for patients at higher infection risk
- Treat bacteriuria before stone surgery
- Consider the effect of residual fragments on recurrence and future kidney function
- Continue metabolic stone work-up and prevention after clearance
Why it matters
Postoperative sepsis is a key risk for patients with CKD undergoing stone surgery.
Don't overread it
Most included studies were observational, so the benefit needs confirmation in randomised trials.
The statistics, in plain English
Credible intervals are the Bayesian equivalent of confidence intervals. The sepsis interval (0.12–0.97) only just excludes no effect. Pooling mostly non-randomised studies can overstate benefit.
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