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Single-use ureteroscopes (SU) paired with 12/14Fr suction ureteral access sheaths (FANS) offer optimal visibility and stone clearance in flexible ureteroscopy (fURS). Reusable ureteroscopes (RU) with larger sheaths showed reduced efficacy, highlighting the importance of scope-sheath matching.

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Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Medical Device Technology

Background:

  • Single-use ureteroscopes (SU) and flexible and navigable suction ureteral access sheaths (FANS) have enhanced flexible ureteroscopy (fURS) efficiency and safety.
  • The impact of specific scope-sheath pairings on fURS outcomes remains less understood.
  • Optimizing instrument combinations is crucial for improving surgical performance in urology.

Purpose of the Study:

  • To compare the outcomes of four different scope-sheath configurations in flexible ureteroscopy (fURS).
  • To evaluate the influence of pairing single-use (SU) and reusable ureteroscopes (RU) with 11/13Fr and 12/14Fr flexible and navigable suction ureteral access sheaths (FANS).
  • To determine the optimal combination for stone-free rates, operative time, visibility, and complications.

Main Methods:

  • Retrospective evaluation of 184 patients undergoing fURS for kidney stones (10-25 mm).
  • Four matched groups were analyzed: RU-11/13FANS, RU-12/14FANS, SU-11/13FANS, and SU-12/14FANS (46 patients each).
  • Endpoints included 30-day stone-free rate (SFR), operative time, surgeon-reported visibility, and postoperative complications.

Main Results:

  • Single-use ureteroscope groups exhibited significantly shorter operative times (p < 0.001) and higher stone-free rates (SFR).
  • The SU-12/14FANS configuration demonstrated the highest visibility scores, while RU-11/13FANS had the lowest.
  • Complication rates were low and comparable across all groups (8.2% overall).

Conclusions:

  • Pairing single-use ureteroscopes (SU) with 12/14Fr FANS provides optimal visibility and effective stone clearance in fURS.
  • Reusable ureteroscopes (RU) with 12/14Fr FANS showed reduced efficacy, potentially due to impaired maneuverability.
  • The interaction between ureteroscopes and sheaths significantly impacts fURS outcomes, emphasizing the need for careful matching.