{
  "abstract": "Background and objective\n\nPrimary ureteroscopy (URS; P-URS) for obstructing ureteric stones involves emergent stone retrieval within 24-48 h of acute presentation. We compared the effectiveness of P-URS versus delayed URS (D-URS) for noninfected obstructing ureteric stones.Methods\n\nA systematic review was conducted using PubMed, Embase, Cochrane Library, and Scopus from database inception up to October 2025. Studies comparing P-URS with D-URS were eligible. Primary outcomes were stone-free rate (SFR) and complications. Secondary outcomes included retreatment, sepsis, stent use, readmissions, and costs. Random-effects meta-analysis and meta-regression were performed for prespecified study-level moderators.Key findings and limitations\n\nFifteen studies involving 19 907 patients were included. Pooled SFR in P-URS was 89% (confidence interval [CI] = 80-95) and D-URS 87% (CI = 77-94). There was no statistically significant difference in SFR between P-URS and D-URS in an all-studies meta-analysis (odds ratio [OR] 1.20; 95% CI = 0.75-1.92; p = 0.5) with substantial heterogeneity (I² = 86%). In a subgroup of five studies using a zero-fragmentation definition on any postoperative imaging modality (radiographic zero fragment rate [ZFR]), P-URS was associated with higher odds of stone-free status (OR 1.49, 95% CI = 1.10-2.02, I² = 0%). Sensitivity analysis restricted to two computed tomography (CT)-based trials (strict ZFR) showed a larger effect (OR 1.95, 95% CI = 1.19-3.19, I² = 0%). Complications and secondary outcomes did not differ materially between approaches. Limitations include methodological heterogeneity, predominantly retrospective designs, and sparse data using strict ZFR definitions.Conclusions and clinical implications\n\nP-URS appears to be a feasible option for selected patients with noninfected obstructing ureteric stones without large overall differences in SFR or complication rates compared with D-URS. In radiographic and strict CT-based ZFR subgroups, P-URS shows modestly higher SFRs, but these signals arise from few studies and should be considered hypothesis generating. Future research should incorporate contemporary technology, patient-reported outcomes, and formal cost-effectiveness analyses.",
  "abstract_shown": true,
  "affiliations": [
    "Strategic Academic Recruitment Programme, Royal College of Surgeons in Ireland, Dublin, Ireland.",
    "Department of Urology and Transplant Surgery, Beaumont Hospital, Dublin, Ireland.",
    "Department of Urology, Blackrock Clinic, Dublin, Ireland.",
    "Department of Urology, National and Kapodistrian University of Athens, Athens, Greece.",
    "Department of Urology, Sismanogleio Hospital, Athens, Greece.",
    "Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK."
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Diarmuid D Sugrue"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Orla Cullivan"
    },
    {
      "affs": [
        1
      ],
      "name": "Fintan R Ryan"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Andreas Skolarikos"
    },
    {
      "affs": [
        5
      ],
      "name": "Bhaskar Somani"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Niall F Davis"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6f6mxx883pwf5.bib",
  "cited_by": 0,
  "doi": "10.1016/j.euros.2026.09.007",
  "fulltext_url": "https://europepmc.org/articles/PMC13677576",
  "id": "6f6mxx883pwf5",
  "issns": [
    "2666-1691",
    "2666-1683"
  ],
  "landing_url": "https://europepmc.org/article/MED/42898237",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Kidney Stones and Urolithiasis Treatments"
    ]
  ],
  "openalex": "W7221068242",
  "pdf_url": "https://europepmc.org/articles/PMC13677576?pdf=render",
  "pmcid": "PMC13677576",
  "pmid": "42898237",
  "published": "2026-10-09",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/6f6mxx883pwf5.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:37Z",
      "native_id": "MED:42898237",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42898237"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Kidney Stones and Urolithiasis Treatments",
      "subfield": "general"
    }
  ],
  "title": "Primary Versus Delayed Ureteroscopy for Obstructing Ureteric Calculi: A Systematic Review and Meta-analysis from the European Association of Urology Endourology.",
  "title_text": "Primary Versus Delayed Ureteroscopy for Obstructing Ureteric Calculi: A Systematic Review and Meta-analysis from the European Association of Urology Endourology.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:37Z",
  "url": "https://research.draconitic.com/paper/6f6mxx883pwf5",
  "venue": "European urology open science",
  "versions": []
}