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<p>Suction in retrograde-intrarenal surgery (RIRS) has been the focus of ongoing innovation. Expanding ranges of flexible vacuum-assisted ureteric access sheaths (FV-UAS) combined with single-use digital flexible ureteroscopes (SU-DFU) produce many potential combinations. This study aims to evaluate the efficacy of these combinations in clearing stone fragments. Three different models of flexible vacuum-assisted ureteric access sheaths were tested: Clear Petra<sup>™</sup> (8.5/9.5Fr, 10-12Fr, 12-14Fr), YiGao<sup>™</sup> (10-12Fr, 12-14Fr) and Innovex<sup>™</sup> (10-12Fr, 12-14Fr). A total of 6 ratio of endoscope-to-sheath diameters (RESDs) (0.53, 0.63, 0.74, 0.79, 0.88 and 0.95) were assessed by using three different single-use digital flexible ureteroscopes (6.3Fr Hugemed<sup>™</sup>, 7.5Fr Pusen<sup>™</sup>, 9.5Fr Lithovue<sup>™</sup>). Two techniques, continuous in-scope suction and pull-out with suction were tested across 5 dust size ranges (63–125, 125–250, 250–500&#xa0;µm and 0.5–1&#xa0;mm, 1–2&#xa0;mm). A combination resulting in a ratio of endoscope-to-sheath diameter of 0.53 offered the best range, with up to 2&#xa0;mm fragments aspirated with equal success by either method. Maximal stone clearance rates at 10.2&#xa0;g/min were achieved with the combination of a 7.5Fr Pusen<sup>™</sup> with 12-14F flexible vacuum-assisted ureteric access sheath, with a ratio of endoscope-to-sheath diameter of 0.63 using continuous in-scope suction for fragments 125–250&#xa0;µm. Continuous in-scope suction emerges as the dominant technique for smaller stone fragments and pull-out with suction as dominant or equivalent for greater fragment sizes. The ratio of endoscope-to-sheath diameter is not the only factor critical to improving stone-free rates. Technique should be adapted according to estimated stone fragment size.</p>

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Size matters: an in vitro evaluation of flexible vacuum-assisted ureteral access sheaths

  • 期刊论文

  • 发表日期：

    2025年5月17日

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  • Aideen Madden,
  • Carlos Altez,
  • Jordi Peña Lueza,
  • Johan Cabrera,
  • Alberto Quarà,
  • Stefano Moretto,
  • Răzvan-Ionut Popescu,
  • Mariela Corrales,
  • Olivier Traxer

摘要

Suction in retrograde-intrarenal surgery (RIRS) has been the focus of ongoing innovation. Expanding ranges of flexible vacuum-assisted ureteric access sheaths (FV-UAS) combined with single-use digital flexible ureteroscopes (SU-DFU) produce many potential combinations. This study aims to evaluate the efficacy of these combinations in clearing stone fragments. Three different models of flexible vacuum-assisted ureteric access sheaths were tested: Clear Petra™ (8.5/9.5Fr, 10-12Fr, 12-14Fr), YiGao™ (10-12Fr, 12-14Fr) and Innovex™ (10-12Fr, 12-14Fr). A total of 6 ratio of endoscope-to-sheath diameters (RESDs) (0.53, 0.63, 0.74, 0.79, 0.88 and 0.95) were assessed by using three different single-use digital flexible ureteroscopes (6.3Fr Hugemed™, 7.5Fr Pusen™, 9.5Fr Lithovue™). Two techniques, continuous in-scope suction and pull-out with suction were tested across 5 dust size ranges (63–125, 125–250, 250–500 µm and 0.5–1 mm, 1–2 mm). A combination resulting in a ratio of endoscope-to-sheath diameter of 0.53 offered the best range, with up to 2 mm fragments aspirated with equal success by either method. Maximal stone clearance rates at 10.2 g/min were achieved with the combination of a 7.5Fr Pusen™ with 12-14F flexible vacuum-assisted ureteric access sheath, with a ratio of endoscope-to-sheath diameter of 0.63 using continuous in-scope suction for fragments 125–250 µm. Continuous in-scope suction emerges as the dominant technique for smaller stone fragments and pull-out with suction as dominant or equivalent for greater fragment sizes. The ratio of endoscope-to-sheath diameter is not the only factor critical to improving stone-free rates. Technique should be adapted according to estimated stone fragment size.