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Small- and large-calibre ureteroscopes: an updated systematic review and meta-analysis
Francesco Di Bello1, Paolo Verri1, Alejandra Bravo-Balado1
1Stone Unit, Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
BJU International
|July 28, 2026
Summary
Small-calibre ureteroscopes demonstrate comparable stone-free rates, complication rates, and operative times to large-calibre ureteroscopes. Further high-quality randomized controlled trials are needed to confirm these findings and address study heterogeneity in ureteroscope comparisons.
Area of Science:
- Urology
- Endourology
- Medical Device Technology
Background:
- Ureteroscope technology has advanced, with ongoing debate regarding the optimal calibre for stone removal procedures.
- Small-calibre ureteroscopes may offer improved maneuverability, while large-calibre scopes might provide better visualization and irrigation.
Purpose of the Study:
- To systematically review and meta-analyze evidence comparing perioperative outcomes between small (≤6.3/7.5 F) and large (≥7.5/9.8 F) calibre ureteroscopes.
- To assess stone-free rates (SFRs), overall complications, and operative time in ureteroscopic procedures based on ureteroscope calibre.
Main Methods:
- A comprehensive literature search was conducted in MEDLINE/PubMed and Scopus following PRISMA guidelines.
- Included studies were evaluated for quality and risk of bias using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool.
- Sensitivity analyses were performed on specific subgroups, including flexible ureteroscopes and randomized controlled trials (RCTs).
Main Results:
- Eight studies (four RCTs, four retrospective) were included in the meta-analysis.
- Comparisons of 6.3- vs 7.5-F ureteroscopes showed no significant differences in SFR (RR 0.99, 95% CI 0.92-1.06), complications (RR 1.08, 95% CI 0.77-1.51), or operative time (SMD -14.5 min, 95% CI -33.4 to 3.3 min).
- Similar outcomes were observed for comparisons between 7.5- vs >7.5-F ureteroscopes.
Conclusions:
- Small-calibre ureteroscopes achieve comparable perioperative outcomes to large-calibre ureteroscopes in the current meta-analysis.
- Significant heterogeneity and residual confounding necessitate well-designed, adequately powered RCTs for definitive conclusions on ureteroscope calibre effectiveness.
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