Clinical efficacy analysis of two different types of ureteral access sheaths in RIRS for the treatment of 2-4 cm renal stones.

Objective: This study aimed to evaluate the safety and efficacy of flexible vacuum-assisted ureteral access sheath (FV-UAS) and intelligent pressure-controlled ureteral access sheath (IPC-UAS) in retrograde intrarenal surgery (RIRS) for the treatment of 2-4 cm renal stones.

Methods: We retrospectively analyzed clinical data from patients who underwent RIRS at the Department of Urology, Ganzhou People's Hospital, between October 2022 and December 2024. Patients were divided into two groups based on the type of ureteral access sheath used during surgery. Clinical outcomes were compared between groups, including stone-free rate (SFR) on postoperative day 1 and month 1 follow-up, complication rate, operative time, average length of hospital stay, and postoperative pain scores.

Results: The FV-UAS group achieved significantly higher SFR compared to the IPC-UAS group, with rates of 84.02% on postoperative day 1 and 88.66% at month 1, versus 74.87% and 80.21%, respectively(P < 0.05). However, the FV-UAS group also exhibited a higher complication rate (15.98%) than the IPC-UAS group (9.44%) (P = 0.043). In cases involving lower pole stones, the use of a stone retrieval basket was notably lower in the FV-UAS group (1.34%) compared to the IPC-UAS group (5.34%) (P = 0.042). No statistically significant differences were observed between the groups in terms of stone composition, operative time, hospital stay duration, or intraoperative hemoglobin loss (P > 0.05).

Conclusion: Both FV-UAS and IPC-UAS are effective and safe for managing large renal stones in RIRS. FV-UAS can achieve a higher SFR, while IPC-UAS demonstrates a lower rate of complications.