A Feasibility Study on Clinical Utility, Efficacy and Limitations of 2 Types of Flexible and Navigable Suction Ureteral Access Sheaths in Retrograde Intrarenal Surgery for Renal Stones

Gauhar, Vineet; Traxer, Olivier; Castellani, Daniele; Ragoori, Deepak; Heng, Chin Tiong; Chew, Ben H.; Somani, Bhaskar K.; Bin Hamri, Saeed

doi:10.1016/j.urology.2023.05.032

Cited by 30 publications

(9 citation statements)

References 29 publications

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“…Chen's initial clinical study demonstrated an average operative time of 70.8 min using 12/14 Fr FANS [46]. In contrast, Gauhar et al observed a shorter operative duration of 63 min using the same-sized FANS and 76 min with a smaller FANS 10/12CH, which highlights the impact of UAS size on operative time [47]. Zhong's study, reported an even shorter duration of RIRS using 12/14 Fr FANS for 34.5 min [48].…”

Section: Results Of Review Of Experimental Studies (Table 1)mentioning

confidence: 99%

“…Most studies had similar definitions of SFR as above, with Chen et al [56] using the stone volume clearance rate instead. Of note, the most significant difference in SFR reported among the studies was Gauhar et al [47], where the size of FANS was compared (10 Fr vs. 12 Fr), with a significantly higher SFR in the 10 Fr group (94.7% vs. 68.8%, p = 0.01). The other trend noted among the studies was the significant change in SFR reported on postoperative day 1 compared to 30 days.…”

Section: Stone Free Ratesmentioning

confidence: 95%

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Scoping Review of Experimental and Clinical Evidence and Its Influence on Development of the Suction Ureteral Access Sheath

Yuen,

Traxer,

Wroclawski

et al. 2024

Diagnostics

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The ureteral access sheath (UAS) has been a boon and a bane in flexible ureteroscopy (FURS), with its merits and demerits well established. Its design and dimensions were instrumental in reshaping the way flexible scopes were used and were key adjuncts to establishing retrograde intrarenal surgery (RIRS) as a standard of care in the endourological management of renal stones. With the ever-changing landscape of RIRS over the decades shaped by technological advancements in lasers and flexible scopes, the UAS has also continuously evolved. The utility of suction in endourology has recently changed the way RIRS is performed and is a game changer for FURS outcomes. With strong clinical and experimental evidence to support its use, the UAS has undergone a transformative change in the recent past, with its ability to monitor intrarenal pressure and provide a superior vacuum-cleaner effect that improves the trifecta of RIRS, namely an improved single-stage stone-free rate (SFR), minimise complications, and reduce reinterventions. Our comprehensive review outlines the key clinical and experimental evidence and traces the developments that were key to modifying the traditional UAS into a flexible and navigable suction ureteric access sheath (FANS) and highlights how the design and modifications, in turn, influence the ability to push the boundaries of RIRS.

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Section: Results Of Review Of Experimental Studies (Table 1)mentioning

confidence: 99%

Section: Stone Free Ratesmentioning

confidence: 95%

Scoping Review of Experimental and Clinical Evidence and Its Influence on Development of the Suction Ureteral Access Sheath

Yuen,

Traxer,

Wroclawski

et al. 2024

Diagnostics

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“…Laser with e cient dusting property, such as TFL, will generate smaller particles and obtain higher stone clearance [21,22] . Smaller caliber endoscopes will bring an ideal scope-sheath ratio allows larger fragments to be aspirated out without scope withdraw, thus enhance the stone clearance [23] .…”

Section: Discussionmentioning

confidence: 99%

Application of tip-bendable ureteral access sheath in flexible ureteroscopic lithotripsy: an initial experience of 224 cases

Liang

Liu

Lin

et al. 2023

Preprint

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Introduction: During the last decades, the advent of flexible ureteroscopic lithotripsy has revolutionized the management of upper urinary tract stones. We designed a patented tip-bendable ureteral access sheath to facilitate stone clearance. Our current study reported our initial experience of 224 cases. Material and methods: The study is a descriptive, retrospective analysis. The initial 224 cases, operated consecutively by one surgeon during 16 months, were reviewed. The novel tip-bendable ureteral access sheath was applied in the procedure. Demographics, laboratory tests, and peri- and postoperative findings (operation duration, stone-free rate (SFR), utilization of flexible instruments and complications) were analyzed. Resutls: The median age of the patients was 56 years and the mean stones size was 2.3 ± 1.3cm. There were 63 cases of upper ureteral stone, 93cases of renal stone and 68 cases of ureteral-renal stones. The mean operative time was 69.2 ± 65.2 minutes. The immediate stone-free rate was 76.8% and the 1 month post-operative stone-free rate was 97.3%. Most cases(95.5%)were success in single session. Two patient experienced post-operative fever. There was no unplanned readmission. The frequency of post-operative complications was estimated at 0.89% (Clavien I). Conclusion: Flexible ureteroscopic lithotripsy with tip-bendable ureteral access sheath is a safe and effective procedure, which can achieve excellent stone clearance.

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“…The new player in stone treatment seems to be the use of suction, which has shown to reduce residual stone fragments and improve the SFR. This has been applied to either the scope or via the sheath and used in both MPCNL and URS treatments [12,13]. Similarly, there seems to be a renewed interest in robotic URS with different new devices providing good surgical outcomes, optimal ergonomics and outcomes which are comparable to conventional flexible URS [14].…”

mentioning

confidence: 99%

“…Aspects of technological innovations also relate to the use of thulium fiber laser and pulsed thulium laser, which have been used for both stone disease and BPH treatment [6,15]. More defined role of suction and intrarenal pressure monitoring is likely to allow for safer and better outcomes [6,12,13]. Most importantly, endo-technological innovations should allow for adaptability in terms of patientcentered outcomes, which are individualized and based on patient preferences, guidelines and incorporating patient-reported outcomes.…”

mentioning

confidence: 99%

Endo-technology and its future: where are we heading?

Somani,

Rassweiler

2024

Current Opinion in Urology

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A Feasibility Study on Clinical Utility, Efficacy and Limitations of 2 Types of Flexible and Navigable Suction Ureteral Access Sheaths in Retrograde Intrarenal Surgery for Renal Stones

Cited by 30 publications

References 29 publications

Scoping Review of Experimental and Clinical Evidence and Its Influence on Development of the Suction Ureteral Access Sheath

Scoping Review of Experimental and Clinical Evidence and Its Influence on Development of the Suction Ureteral Access Sheath

Application of tip-bendable ureteral access sheath in flexible ureteroscopic lithotripsy: an initial experience of 224 cases

Endo-technology and its future: where are we heading?

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