Suction-Assisted Ureteroscopy for Renal Stones &Le; 2 Cm: A Systematic Review, Bayesian Network Meta-Analysis and Meta-Regression

Why It Matters

Suction‑assisted ureteroscopy can raise clearance rates and lower complications, offering urologists a more efficient, cost‑effective option for small renal stones.

Key Takeaways

• FANS yields 2.5× higher stone‑free odds versus standard URS.
• Calyxo CVAC suction achieves highest stone‑free odds (OR 5.6).
• FANS cuts operative time by ~4.5 minutes per case.
• Post‑operative fever odds drop 63% with FANS.
• Evidence for DISS remains sparse and inconclusive.

Pulse Analysis

The rise of suction‑assisted flexible ureteroscopy reflects a broader shift toward technology‑driven efficiency in endourology. By integrating aspiration directly into the working channel, FANS devices create a negative‑pressure environment that actively evacuates stone fragments, reducing the need for basket retrieval. This mechanistic advantage translates into higher stone‑free rates, as the meta‑analysis shows a 2.5‑fold odds increase over conventional URS, and a notable reduction in operative time—factors that directly impact operating‑room throughput and patient turnover.

From a safety perspective, the analysis highlights a 63% drop in post‑operative fever and a 60% reduction in overall complications when using FANS. These outcomes are especially relevant given the growing emphasis on value‑based care, where lower infection rates can diminish readmission costs and improve hospital quality metrics. Moreover, the modest time savings per case accumulate across high‑volume centers, potentially freeing resources for additional procedures and enhancing revenue streams without compromising care standards.

While direct‑in‑scope suction systems like Calyxo CVAC show promising stone‑free odds, the evidence base remains thin, limiting definitive conclusions. The current data suggest that broader adoption will hinge on larger, multicenter trials that assess long‑term outcomes, cost‑effectiveness, and learning curves. For investors and device manufacturers, the findings signal a fertile market for next‑generation ureteroscopic platforms that combine suction capability with ergonomic design, positioning them to capture a growing segment of the urology equipment market.