Departamento de Urologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
Departamento de Medicina, Universidade Evangélica de Goiás, Anápolis, GO, Brasil.
Int Braz J Urol. 2024 Nov-Dec;50(6):670-682. doi: 10.1590/S1677-5538.IBJU.2024.0452.
The ureteral access sheath (UAS) is a medical device that enables repeated entrance into the ureter and collecting system during retrograde intrarenal surgery (RIRS). Its impact on stone-free rates, ureteral injuries, operative time, and postoperative complications remains controversial. Therefore, we performed a systematic review and meta-analysis comparing RIRS with versus without UAS for urolithiasis management.
To compare outcomes from retrograde intrarenal surgery (RIRS) for stone extraction with or without ureteral access sheath (UAS); evaluating stone-free rate (SFR), ureteral injuries, operative time, and postoperative complications.
We systematically searched PubMed, Embase, and Cochrane Library in June 2024 for randomized controlled trials (RCTs) evaluating the efficacy and safety outcomes of UAS use in RIRS for urolithiasis treatment. Articles published between 2014 and 2024 were included. Pooled risk ratios (RRs) and mean differences (MDs) were calculated for binary and continuous outcomes, respectively.
Five RCTs comprising 466 procedures were included. Of these, 246 (52.7%) utilized UAS. The follow-up ranged from 1 week to 1 month. UAS reduced the incidence of postoperative fever (RR 0.49; 95% confidence interval [CI] 0.29-0.84; p=0.009), and postoperative infection (RR 0.50; 95% CI 0.30-0.83; p=0.008). There were no significant differences between groups in terms of SFR (RR 1.05; 95% CI 0.99-1.11; p=0.10), ureteral injuries (RR 1.29; 95% CI 0.95-1.75; p=0.11), operative time (MD 3.56 minutes; 95% CI -4.15 to 11.27 minutes; p=0.36), or length of stay (MD 0.32 days; 95% CI -0.42 to 1.07 days; p=0.40).
UAS leads to a lower rate of post-operative fever and infection. However, UAS did not significantly reduce or increase the SFR or the rate of ureteral injuries during RIRS for patients with urolithiasis. The use of UAS should be considered to decrease the risk of infectious complications, particularly in those who may be at higher risk for such complications.
输尿管.access 鞘（UAS）是一种医疗器械，可在逆行性肾内手术（RIRS）期间重复进入输尿管和收集系统。其对无结石率、输尿管损伤、手术时间和术后并发症的影响仍存在争议。因此，我们进行了系统评价和荟萃分析，比较了有和没有 UAS 的 RIRS 治疗尿石症的效果。
比较逆行性肾内手术（RIRS）治疗结石时使用和不使用输尿管 access 鞘（UAS）的结果；评估无结石率（SFR）、输尿管损伤、手术时间和术后并发症。
我们于 2024 年 6 月系统地检索了 PubMed、Embase 和 Cochrane 图书馆，以评估 UAS 在 RIRS 治疗尿石症中的疗效和安全性的随机对照试验（RCT）。纳入 2014 年至 2024 年期间发表的文章。分别对二项和连续结局计算了汇总风险比（RR）和均数差（MD）。
纳入了 5 项 RCT 共 466 例手术。其中 246 例（52.7%）使用了 UAS。随访时间为 1 周至 1 个月。UAS 降低了术后发热的发生率（RR 0.49；95%置信区间[CI] 0.29-0.84；p=0.009）和术后感染（RR 0.50；95% CI 0.30-0.83；p=0.008）。两组在 SFR（RR 1.05；95% CI 0.99-1.11；p=0.10）、输尿管损伤（RR 1.29；95% CI 0.95-1.75；p=0.11）、手术时间（MD 3.56 分钟；95% CI -4.15 至 11.27 分钟；p=0.36）或住院时间（MD 0.32 天；95% CI -0.42 至 1.07 天；p=0.40）方面无显著差异。
UAS 可降低术后发热和感染的发生率。然而，UAS 并未显著降低或增加 RIRS 治疗尿石症患者的 SFR 或输尿管损伤率。考虑使用 UAS 可降低感染性并发症的风险，特别是对那些可能存在更高并发症风险的患者。
