Flexible versus rigid ureteroscopy in the management of proximal ureteric calculi: a systematic review and meta-analysis from EAU Endourology comparing perioperative outcomes and complication rates.

Abstract

<h4>Purpose of review</h4>Urolithiasis is a common condition, with an increasing prevalence. Rigid ureteroscopy (rURS) and flexible ureteroscopy (fURS) are two management approaches for proximal ureteric calculi. The aim of this systematic review and meta-analysis was to compare perioperative outcomes in rURS versus fURS in the management of proximal ureteric calculi.<h4>Recent findings</h4>This systematic review was conducted according to PRISMA guidelines. Systematic search of online databases was performed in November 2024. A combination of MeSH and free text terms were applied. Primary outcome was stone free status. Secondary outcomes included operative time, complication rates, and hospital stay. Six studies met inclusion criteria, in which a total of 1085 patients underwent ureteroscopy (fURS, n  = 537 versus rURS, n  = 548). Five studies were retrospective comparative, one was prospective randomized comparative. FURS use was associated with significantly superior stone free rates (92%) when compared with rURS (84.5%) ( P  < 0.001). Secondary outcomes of complication rates ( P  = 0.17), length of stay ( P  = 0.39), and operative time ( P  = 0.08) did not reach statistical significance.<h4>Summary</h4>Both rURS and fURS have acceptable stone clearance and complication rates for managing proximal ureteric calculi. Regarding stone clearance, fURS is superior to rURS, both interventions are comparable with regards to complications, operative time, and hospital stay.