Application Of Ureteral Access Sheath And Failure Rate Of Ureteral Access Sheath Insertion During Ureteroscopy Lithotripsy Of Associated Clinical Factors In Asia:A Meta-analysis

Objective:To analyse the Application of ureteral access sheath(UAS)and Failure rate of ureteral access sheath insertion during Ureteroscopic lithotripsy of associated clinical factors in an Asian population.Methods:Eligible clinical studies were searched from databases of the Cochrane Library,Pub Med,Embase,Wanfang Data and CNKI from inception to September.2022.Revman5.3 and R4.2.1was used for meta-analysis.Results:A total of 18 studies were included.The Meta-analysis showed that stone free rate(SFR)in the ureteral access sheath group was higher than that in the control group(OR=1.49,95%CI:1.23～1.80,P<0.05).There was no significant difference in operative complication and Operation time between the two groups(p>0.05).Patients who were older(MD=4.34,95% CI: 2.51-6.18,p<0.01)and had a larger maximum stone diameter(MD=1.17,95% CI: 0.41-1.93,p=0.002)were more likely to have successful sheath placement.Patients who were male(OR=0.46,95% CI: 0.30-0.70,P<0.01),had a higher BMI(MD=-1.39,95% CI:-2.57-0.21,P=0.02)and combined with hydronephrosis(OR=0.47,95% CI: 0.30-0.74,P=0.001)were more likely to have failed UAS placement.Conclusion:1.In the treatment of upper urinary tract stones in Asian populations,the use of UAS can improve stone free rate,but does not increase the risk of intraoperative and postoperative complications.2.Clinical factors of patients with failed UAS placement in the Asian population include younger age,smaller stones,male,higher BMI,and combined hydronephrosis.