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

Purpose: 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.

Materials And Methods: 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.

Results: 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.

Conclusion: 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.