RIRS with flexible vacuum-assisted UAS versus MPCNL for impacted upper ureteral stones: a prospective, randomized
Qing-Lai Tang1, Ping Liang2, Ling-Hui Li3
1Department of Urology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Urolithiasis
|June 4, 2025
Summary
Retrograde intrarenal surgery with flexible vacuum-assisted ureteral access sheath (FV-UAS) offers comparable stone-free rates to minimally invasive percutaneous nephrolithotomy for impacted upper ureteral stones. This approach significantly improves quality of life and reduces complications.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Nephrolithiasis Management
Background:
- Impacted upper ureteral stones (IUUS) present a significant clinical challenge.
- Current treatment options include minimally invasive percutaneous nephrolithotomy (MPCNL) and retrograde intrarenal surgery (RIRS).
- The efficacy and safety of combining RIRS with flexible vacuum-assisted ureteral access sheath (FV-UAS) for IUUS require further investigation.
Purpose of the Study:
- To compare the efficacy and safety of RIRS combined with FV-UAS versus MPCNL for treating impacted upper ureteral stones.
- To evaluate key outcomes including stone-free rates, operative time, blood loss, hospital stay, quality of life, and complications.
Main Methods:
- A comparative study involving 189 patients with IUUS, divided into an FV-UAS group (95 patients) and an MPCNL group (94 patients).
- Primary outcome: stone-free rates (SFRs) on postoperative day 1.
- Secondary outcomes: SFRs at 1 month, operative time, hemoglobin reduction, hospital stay, quality of life (QoL) scores, ureteral stricture incidence, and complications.
Main Results:
- Both groups showed similar stone-free rates on postoperative day 1 and at 1 month.
- The FV-UAS group experienced significantly lower hemoglobin reduction (5.1 vs. 14.7 g/L) and shorter hospital stays (2.7 vs. 4.9 days).
- Quality of life improvement was significantly higher in the FV-UAS group (32.5 vs. 27.1), with a markedly lower overall complication rate.
Conclusions:
- RIRS with FV-UAS is a promising alternative for treating impacted upper ureteral stones, achieving comparable stone clearance to MPCNL.
- FV-UAS offers significant advantages in reduced blood loss, shorter hospital stay, enhanced quality of life, and fewer complications.
- This technique represents an effective and safe option for managing IUUS.
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