Clinical and cost-effectiveness outcomes of suction-assisted ureteral access sheaths in retrograde intrarenal surgery: evidence from a propensity score-matched cohort.

OBJECTIVE: To compare the clinical efficacy and cost-effectiveness of suction-assisted ureteral access sheath (S-UAS) and traditional UAS (T-UAS) for retrograde intrarenal surgery (RIRS) in a retrospective single-center cohort study. METHODS: Patients who underwent RIRS between January 2020 and January 2025 were included. Propensity score matching was used to balance baseline characteristics between groups. The primary outcomes were stone-free rates (SFRs), complication profiles, intraoperative visibility (rated on a Likert scale), and cost-effectiveness. RESULTS: Following matching, 180 patients (90 per arm) remained. The S-UAS group had a significantly shorter operative time (60.3 vs. 71.9 min, p = 0.007), greater SFR (90% vs. 78.9%, p = 0.040), and lower complication rate (11.1% vs. 25.5%, p = 0.012). Visibility scores significantly improved in the S-UAS arm at the middle and late phases of the operation. Despite higher entry costs, S-UAS had lower costs per stone-free patient ($1958 vs. $2253) and an encouraging incremental cost-effectiveness ratio (ICER) of $126 per additional SFR outcome. CONCLUSION: The S-UAS enhances the success of RIRS by improving visibility, reducing infectious complications, and increasing the SFR. It may seem more expensive at first, but it ultimately proves to be more economical in the long run. These findings support broader adoption of S-UASs in clinical practice; however, prospective, randomized studies are needed to validate these results.