Comparative study of ureteral access sheath versus suction access sheath in retrograde intrarenal surgery

Retrograde intrarenal surgery (RIRS) is a minimally invasive technique for managing renal and upper ureteral stones. Ureteral access sheaths (UAS) facilitate instrument access and reduce intrarenal pressure, but their impact on stone-free rates (SFR) remains debated. Suction ureteral access sheaths (S-UAS) offer improved flexibility and can be connected to suction devices, enhancing stone fragment removal. This study aims to compare the outcomes of traditional UAS and S-UAS in RIRS.

A retrospective cohort study was conducted at Chimei Medical Center from January 2022 to December 2024, including 104 patients who underwent RIRS with either traditional UAS (n = 53) or S-UAS (n = 51). Baseline characteristics, operative time, stone-free rates (SFR), postoperative complications, and the need for auxiliary procedures were analyzed. Stone-free was defined as absence of residual fragments > 4 mm (and > 2 mm for stricter assessment) on KUB. Subgroup analyses assessed the impact of stone size, location, and number on outcomes.

Immediate clinically acceptable SFR was significantly higher in the S-UAS group (82.0%) compared to the traditional UAS group (60.4%) (p = 0.016). At one month, no significant difference was observed between the groups. The S-UAS group required fewer auxiliary procedures (5.9% vs. 22.6%, p = 0.015) and demonstrated a higher SFR for lower calyx stones (81.8% vs. 55.2%, p = 0.046). Operative time, hospital stay, and complication rates were similar between groups.

The S-UAS facilitates efficient stone dust evacuation, improves immediate clinically acceptable SFRs, and reduces auxiliary procedure rates without increasing complications. These findings support its use in RIRS, particularly in select stone characteristics. Prospective studies with larger cohorts and standardized imaging follow-up are warranted to validate these results.

not applicable.