Dados do Trabalho

Título

URETEROSCOPY WITH VERSUS WITHOUT URETERAL ACCESS SHEATH: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Introdução e Objetivo

The ureteral access sheath is a medical device that enables repeated entrance into the ureter and collecting system during stone extraction by ureteroscopy. Its impact on stone-free rates, ureteral injuries, operative time, and postoperative complications remains controversial. Therefore, we aimed to perform a systematic review and meta-analysis comparing ureteroscopy with versus without  ureteral access sheath.

Método

We systematically searched PubMed, Embase, and Cochrane Library in April 2023 for randomized controlled trials addressing the impact of ureteral access sheath during ureteroscopy for the treatment of urolithiasis in terms of efficacy and safety outcomes. Pooled risk ratios and mean differences were computed for binary and continuous outcomes, respectively. Review Manager 5.4.1 and IBM Statistical Package for the Social Sciences Statistics version 27.0 were used for statistical analyses. 

Resultados

We included eight randomized controlled trials comprising 739 patients undergoing 742 ureteroscopies for stone extraction; 386 (52%) were performed with ureteral access sheath. Average follow-up ranged from 2 weeks to 1 year. Ureteral access sheath reduced the incidence of postoperative fever (risk ratio 0.42; 95% confidence interval 0.26–0.70; p<0.001; Figure 1A). There was no significant difference between groups in postoperative urinary tract infection (risk ratio 0.59; 95% confidence interval  0.19–1.80; p=0.36); stone-free rate (risk ratio 1.02; 95% confidence interval 0.97–1.08; p=0.41; Figure 1B); ureteral mucosal and submucosal injuries (risk ratio 1.18; 95% confidence interval 0.88–1.58; p=0.28; Figure 1C); ureteral perforations (risk ratio 0.39; 95% confidence interval 0.03–5.09; p=0.47); operative time (mean difference -4.03 minutes; 95% confidence interval -8.85 to 0.80 minutes; p=0.10); or length of stay (mean difference 0.22 days; 95% confidence interval -0.56 to 1.00 days; p=0.58).

Conclusão

In this meta-analysis of randomized controlled trials, ureteral access sheath did not significantly reduce or increase the stone-free rate or the rate of ureteral injuries during ureteroscopy for patients with urolithiasis, albeit ureteral access sheath was associated with a significant reduction in the incidence of postoperative fever. Therefore, physicians should individualize their decision-making on the use of a ureteral access sheath based on patient characteristics and procedural considerations.