Feasibility of flexible and navigable suction ureteral access sheath in pediatric ureteroscopy: A systematic review from the European Association of Urology Section of Endourology.

OBJECTIVE

The introduction of a flexible and navigable suction ureteral access sheath (FANS-UAS) has further enhanced retrograde intrarenal surgery (RIRS) by improving kidney stone clearance and reducing operative challenges. However, evidence for its use in the pediatric population remains sparse. Thus, this systematic review focuses on the current evidence on the use of a FANS-UAS during RIRS in children with renal stones.

METHODS

A systematic search of PubMed, Cochrane Library, and Google Scholar was conducted in May 2025 following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and PROSPERO registration (CRD420251049140). Studies were included if they reported original data on the use of a suction ureteral access sheath (UAS) during RIRS in pediatric patients (<18 years). Data on patient demographics, stone characteristics, surgical outcomes, and complications were extracted and analyzed descriptively.

RESULTS

Out of 49 screened studies, three met the inclusion criteria, including 74 pediatric patients. A FANS-UAS was used in all cases, with 97% utilizing 10/12 Fr UAS and 91% employing a 7.5 Fr flexible ureteroscope. The pooled stone-free rate was 99%, with complications limited to minor ureteral injury (4.1%) and Clavien-Dindo Grade I/II events (9.5%). One study showed the superiority of a FANS-UAS over a conventional UAS in operative time and initial stone-free rate. However, the evidence was limited by small sample sizes and heterogeneity.

CONCLUSION

RIRS with a FANS-UAS a is a safe and effective option for managing pediatric urolithiasis, including large and multiple stones. Nevertheless, current evidence is based on a small number of studies with limited generalizability. Further prospective research is needed to validate these findings, to explore the role of suction, and to investigate various UAS and endoscope configurations.