Efficacy and safety of flexible ureteroscopy with intelligent pressure-controlled ureteral access sheath: a systematic review and meta-analysis.

OBJECTIVE

To systematically evaluate the clinical outcomes and safety of intelligent pressure-controlled ureteral access sheaths (IPC-UAS) compared with conventional ureteral access sheaths (UAS), flexible vacuum ureteral access sheath (FANS), or percutaneous nephrolithotomy (PCNL).

METHODS

A systematic literature search was conducted in Scopus, Web of Science, and PubMed/MEDLINE for studies published up to November 15, 2025. Studies involving patients undergoing flexible ureteroscopy (f-URS) with IPC-UAS were included. Primary outcomes were stone-free rates (SFR) and complication rates, while secondary outcomes included operative time, intrarenal pressure control, retreatment rate, and readmission rate.

RESULTS

A total of 15 studies including 2293 patients were analyzed. In the IPC-UAS group, SFR ranged from 80.2 to 95.6% at 1 month. Meta-analyses detected no statistically significant difference in 1-month SFR between IPC-UAS and PCNL (p=0.160) or between IPC-UAS and FANS (p=0.109), whereas IPC-UAS was associated with a higher SFR than conventional UAS in a single study (p=0.032). Postoperative complications in the IPC-UAS group ranged from 2 to 34.7% and were predominantly minor. IPC-UAS was associated with significantly lower complication rates compared with PCNL (p=0.024), while no statistically significant differences were detected compared with conventional UAS or FANS (p=0.390, p=0.453, respectively). No statistically significant differences were detected among the groups in intraoperative complications, operative time, and retreatment rates.

CONCLUSION

The available evidence suggests that IPC-UAS may be an emerging option for f-URS; however, current comparative data are insufficient to establish equivalence or superiority over other types of UAS and PCNL. Given the heterogeneity and limited precision of the available evidence, its potential clinical benefits require further evaluation in well-designed prospective randomized studies.