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Do aspiration-assisted access sheaths improve outcomes in miniaturized percutaneous nephrolithotomy? A systematic
M E Martínez-Corral1, C Fernández-Baltar2, R Martínez-Corral1
1Unidad de Endourología, Servicio de Urología, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain.
Objective:
To compare vacuum-assisted and conventional percutaneous access sheaths used during miniaturized percutaneous nephrolithotomy (mini-PCNL), evaluating their efficacy and safety.
Methods:
A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and prospectively registered in PROSPERO (CRD420251272303). PubMed, Web of Science, and Scopus were searched to identify randomized controlled trials and comparative observational studies evaluating vacuum-assisted (vm-PCNL) versus conventional mini-PCNL (cm-PCNL). Primary outcomes were stone-free rate and overall postoperative complications. Secondary outcomes included operative time, length of hospital stay, and the need for ancillary procedures. Quantitative synthesis was performed using random-effects models with Review Manager version 5.4.
Results:
Nineteen studies comprising 4079 patients were included. Stone-free rate was significantly higher in the vm-PCNL group compared with cm-PCNL (RR = 1.09; p = 0.0001). Vacuum-assisted techniques were associated with significantly lower rates of overall complications (RR = 0.56, p < 0.00001), infectious complications (RR = 0.50, p < 0.00001), and hemorrhagic complications (RR = 0.61, p = 0.03). Operative time was significantly shorter with vm-PCNL, with a mean reduction of 17.5 min (p < 0.00001). No statistically significant difference was observed in length of hospital stay (p = 0.06). In addition, vm-PCNL was associated with a lower need for ancillary procedures (RR = 0.59, p = 0.002).
Conclusions:
Vacuum-assisted percutaneous access sheaths are associated with improved efficacy and safety outcomes during mini-PCNL compared with conventional sheaths. The available evidence supports their role in enhancing stone clearance, reducing postoperative morbidity, and improving operative efficiency, and suggests that suction-assisted access sheaths should be strongly considered in contemporary mini-PCNL practice, particularly in settings where effective intrarenal pressure control and efficient fragment evacuation are critical.