Use of the ureteral access sheath during ureteroscopy: A systematic review and meta-analysis

• Published in: PloS one Vol. 13; no. 2; p. e0193600
• Main Authors: Huang, Jian, Zhao, Zhijian, AlSmadi, Jad Khaled, Liang, Xiongfa, Zhong, Fangling, Zeng, Tao, Wu, Weizhou, Deng, Tuo, Lai, Yongchang, Liu, Luhao, Zeng, Guohua, Wu, Wenqi
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 28.02.2018; Public Library of Science (PLoS)
• Subjects: Biology and Life Sciences; Clinical trials; Cohort analysis; Complications; Hospitals; Humans; Laboratories; Laparoscopy; Libraries; Medical ethics; Medicine and Health Sciences; Meta-analysis; Nitric-oxide synthase; Physical Sciences; Prospero protein; Quality assessment; Research and Analysis Methods; Science Policy; Sensitivity analysis; Software; Studies; Subgroups; Surgery; Systematic review; Test procedures; Ureter; Ureteroscopy; Ureteroscopy - methods; Urology; Urology devices; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0193600

The debate still rages on for the usefulness of ureteral access sheath (UAS). Therefore, a meta-analysis to discuss the effects of applying UAS during ureteroscopy was performed. The protocol for the review is available on PROSPERO (CRD42017052327). A literature search was conducted up to November, 2017 using the Web of science, PUBMED, EMBASE and Cochrane Library. The quality of articles was assessed by the Jadad scale and Newcastle Ottawa Scale (NOS). Egger's test and the trim-and-fill method were used to evaluate publication bias. Effect sizes were calculated by pooled odds ratio (ORs) and mean differences (MDs). Sensitivity analyses and subgroup analyses were performed to explore the origin of heterogeneity. Eight trials with a total of 3099 patients and 3127 procedures were identified. Results showed no significant difference in stone-free rate (SFR) (OR = 0.83, 95% CI 0.52-1.33, P = 0.45), intraoperative complications (OR = 1.16, 95% CI 0.81-7.69, P = 0.88), operative time (MD = 4.09, 95% CI -15.08-23.26, P = 0.68) and hospitalization duration (MD = -0.13, 95% CI -0.32-0.06, P = 0.18). However, the incidence of postoperative complications was higher in UAS group (OR = 1.46, 95% CI 1.06-2.00, P = 0.02). Evidence from meta-analysis indicated that the use of UAS during ureteroscopy did not manifest advantages. However, given the intrinsic restrictions of the quality of selected articles, more randomized controlled trials (RCTs) are warranted to update the findings of this analysis.