Is the ablation stone efficacy and efficiency better with a flexible and navigable suction ureteric access sheath?

To compare the ablation efficacy and efficiency of flexible and navigable suction ureteric access sheath (FANS) and conventional ureteral access sheath (c-UAS) in retrograde intrarenal surgery (RIRS) for kidney stones treatment.

A retrospective study of 96 patients who underwent RIRS using thulium fiber laser was performed. We divided the patients into Group 1: FANS and Group 2: c-UAS. We assessed the lithotripsy efficiency (mm³/Joules), ablation efficacy (mm³/min), and laser energy consumption (Joules/mm³). The stone-free rate (SFR) was defined as the absence of stone fragments in a non-contrast abdominal computed tomography 4-weeks after the procedure.

Both groups presented comparable stone volume (mm³) and stone density. RIRS with FANS presented a significantly lower surgical time and laser energy consumption (10.9 vs. 12.1 Joules/mm³, p < 0.001). In addition, FANS presented higher ablation efficiency (0.22 vs. 0.09 mm³/Joules, p < 0.001) and ablation efficacy (26.1 vs. 19.9 mm³/min, p < 0.001). SFR was significantly higher in the FANS group (93.7% vs. 75%, p < 0.001).

Compared to c-UAS, RIRS with FANS was associated with decreased total operative time and laser energy consumption and presented a significantly higher ablation efficacy and efficiency. Additionally, SFR was significantly higher in the FANS group.