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New ureteral access sheaths: a double standard.

Shubha De1, Carl Sarkissian1, Fabio C M Torricelli1

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This study compared ureteral access sheath (UAS) performance, finding the Navigator HD most slippery and rigid. Single-wire UAS designs exhibited lower buckling forces but higher dilator removal forces, with Cook sheaths causing minimal tissue trauma.

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Area of Science:

  • Urology
  • Medical Device Engineering
  • Biomedical Materials Science

Background:

  • Ureteral access sheaths (UAS) are crucial for minimally invasive urologic procedures.
  • Evaluating the functional characteristics of traditional and novel UAS designs is essential for optimizing patient outcomes and procedural efficiency.

Purpose of the Study:

  • To comprehensively assess and compare the performance of four distinct ureteral access sheath (UAS) configurations.
  • Key functional characteristics investigated include insertion ease, positioning stability, potential for tissue injury, and overall durability.

Main Methods:

  • Four ureteral access sheaths (UAS) were evaluated: Navigator HD (Boston Scientific), Re-Trace (Coloplast), Flexor-Parallel (Cook Medical), and Flexor-Regular (Cook Medical).
  • Testing encompassed sharpness (foil perforation, tissue skiving), rigidity (tip bending, sheath buckling), lubricity, dilator removal force, kinking resistance, and radiopacity.
  • Measurements were conducted using a motorized sliding stage and a digital force gauge for continuous force recording.

Main Results:

  • Navigator HD demonstrated the largest diameter and superior lubricity, while Re-Trace featured the longest and most flexible tip.
  • Cook Medical sheaths (Flexor-R and Flexor-P) exhibited higher tip perforation resistance and caused the least tissue damage during advancement.
  • Single-wire UAS designs showed lower buckling forces but required greater force for dilator removal compared to classic systems.

Conclusions:

  • The Navigator HD excelled in lubricity and rigidity, whereas single-wire systems offered improved buckling resistance at the cost of higher dilator removal forces.
  • Cook Medical sheaths were identified as the least traumatic, suggesting a favorable profile for minimizing intrarenal injury during ureteroscopy.