Intraoperative positioning strategies to improve stone-free outcomes during retrograde intrarenal surgery: a systematic review and meta-analysis

To evaluate whether intraoperative patient positioning strategies improve stone-free outcomes and safety compared with standard lithotomy during retrograde intrarenal surgery (RIRS) for renal calculi.

PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, and SinoMed were searched from inception to December 2025. Comparative studies of intraoperative positioning strategies versus standard lithotomy during RIRS were included. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models where quantitative synthesis was appropriate. Subgroup analysis by stone location and exploratory sensitivity analyses according to dominant gravitational axis and CT-based outcome assessment were performed.