Suction in mini-percutaneous nephrolithotomy: a meta-analysis from the European Association of Urology Section of Endourology.

Objective: To conduct a meta-analysis comparing the outcomes of vacuum-assisted access sheath (VAAS) mini-percutaneous nephrolithotomy (mPCNL) vs conventional access sheath (CAS) mPCNL.

Methods: A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, with registration in PROSPERO (CRD42024619780). A comprehensive search identified comparative studies (randomised controlled trials and observational studies). The primary outcomes included operating time, stone-free rate (SFR) and complications. Secondary outcomes included transfusion rates, haemoglobin deficit, and length of hospital stay. Data were analysed using Review Manager V5.4, with quality of evidence assessed using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) tool.

Results: Fourteen studies with 2510 patients (1298 in the VAAS and 1212 in the CAS mPCNL groups) were included. VAAS mPCNL significantly reduced operating time, by 17.45 (13.12-21.79) min (P < 0.001), and was associated with a higher SFR: odds ratio (OR) 1.92 (95% confidence interval [CI] 1.57, 2.35; P < 0.001). The VAAS mPCNL group also had a lower postoperative fever rate (OR 0.45 [95% CI 0.35, 0.61]; P < 0.001) and a lower sepsis rate (OR 0.45 [95% CI 0.22, 0.93]; P = 0.03). The overall complication rate for VAAS mPCNL was significantly lower than for CAS mPCNL (P < 0.001), with fewer minor complications. Hospital stay was shorter for VAAS mPCNL (mean reduction of 0.79 days; P = 0.03). There were no significant differences in transfusion rates (OR 0.78 [95% CI 0.46, 1.31]; P = 0.3) or haemoglobin deficit (0.00 g/dL [95% CI 0.22-0.22]; P > 0.9).

Conclusion: The use of VAAS mPCNL offers significant advantages over CAS mPCNL, including shorter operating time, improved stone clearance, and reduced complications. These findings support the use of VAAS mPCNL in managing kidney stones, with further high-quality studies recommended.