Exploring the use of suction evacuation sheath for surgical treatment of renal stones during ureteroscopy: An analysis of 2284 cases

Abstract

Stone-free rates have drastically improved due to technological advancements in the field of endourology. One such advancement has been the use of suction evacuation sheaths (SES) during ureteroscopy (URS). Studies about outcomes after SES URS have been limited by small sample sizes. Here, we performed an analysis of postoperative outcomes of 2284 patients who underwent SES URS for the treatment of renal stone disease. We found that 86% of patients were stone-free at one month, with 50% of patients not requiring any repeat procedures for stone clearance. 1.28% experienced a major complication (Clavien-Dindo ≥ 3); 4.6% had postoperative fever, and 1.28% experienced sepsis after surgery. Ureteral injuries were seen in 1.5% of patients. Stone burden (OR 0.45 [0.33–0.62]) and the requirement of stent placement after lithotripsy (OR 0.71 [0.54–0.95]) were associated with lower SFR, while the use of basket during URS doubled the chances of being stone-free (OR 2.17 [1.33–3.53]). Age, while statistically significant, was not clinically relevant (OR 0.97 [0.96–0.98]). Our study is limited by its retrospective nature and the absence of a comparator group. Nonetheless, this study represents the largest cohort of patients to undergo SES URS for renal stone disease, and demonstrates that SES URS is a safe and efficacious technique for stone removal, with an SFR of 86% at one-month, and a 1.28% sepsis rate after surgery. Manual stone extraction in these patients can double their chances of being stone-free, thus highlighting that the use of SES alone is insufficient during URS.