Flexible suction ureteral access sheath: A game-changer for reducing high-power laser use in retrograde intrarenal...

This study compares the effectiveness and safety of a novel flexible and navigable suction (FANS) ureteral access sheath (UAS), utilizing a lower-power holmium laser (LPHL), against conventional UAS (cUAS) with a high-power holmium laser (HPHL) for retrograde intrarenal surgery (RIRS) in treating renal stones.

Patients aged 18 years and older undergoing RIRS for renal stones were enrolled, excluding those with uncontrolled urinary tract infections, simultaneous ureteral stones, radiolucent stones, and abnormal anatomy. The FANS-UAS group used an LPHL with fixed fragmentation setting, while the cUAS group used an HPHL for both dusting and fragmentation. Outcomes included stone-free status (SFS) rates on day 1, week 1, month 1, operative time, and complications.

Seventy patients (41 males, 29 females) with a median age of 55.5 years underwent 34 cUAS and 36 FANS-UAS procedures. The complete stone-free rate in the FANS-UAS group was higher across all measured time points (63 %, 66.7 %, and 72.2 % at the first day, one week, and one month respectively) compared to the cUAS group (23.5 %, 35.2 %, and 50 %). Multivariable analysis confirmed that using FANS-UAS significantly increased the degree of SFS across these intervals. Furthermore, the FANS-UAS group had a significantly shorter mean operative time (60 ± 26.5 min) than the cUAS group (69.2 ± 30.1 min, p = 0.028). Both groups showed comparable complication rates and negligible serious adverse events.

RIRS with FANS-UAS demonstrated higher early SFS and shorter operative times compared to cUAS, offering efficiency and reduced dependency on HPHL with minimal complications.