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Introduction <p>Retrograde intrarenal surgery with flexible ureteroscopes (FURS) is considered gold-standard for treatment of small renal stones, and this procedure often employs the use of a ureteral access sheath. Recently, flexible and navigable suction access sheaths (FANS) have entered the market. FANS are usually bent together with the FURS, which could reduce the maximum deflection angle of the ureteroscope. This study aims to report FURS´ deflection angle loss when employing FANS.</p> Materials and methods <p>Active downward deflection was measured in vitro in all possible permutations between different FURS, FANS, and working channel instruments. 8 different flexible ureteroscopes were utilized. FANS (ClearPetra™, Well Lead Medical®, China) included multiple diameters from 10/12 to 13/15 Fr. Two deflection techniques were utilized: 1) Sheath Advancement: deflecting the FURS first and advancing the FANS over the scope, and 2) Ureteroscope Deflection: deflecting both the FANS and scope together by having the FURS tip and the distal tip of the FANS.</p> Results <p>A total of 120 measurements were determined. Ureteroscope shaft size was not associated with deflection loss (DL), for all scenarios except when using no fiber and sheath advancement technique (<i>p</i> &lt; 0.05). When controlling for FANS sizes, larger sheaths statistically increased the DL, regardless of technique or working channel occupancy, with all <i>p</i> values &lt; 0.01. In every scenario, DL was higher when using ureteroscope deflection technique than sheath advancement (<i>p</i> &lt; 0.001), with higher difference when the working channel was free without laser fibers (<i>p</i> &lt; 0.05).</p> Conclusions <p>While all FURS presented deflection loss when using FANS, smaller FANS diameters were associated with less DL. Preoperative planning with selection of the optimal FANS diameter for the specific FURS utilized may allow for maximal suction without compromising the deflection needed for precise navigation in the collection system to the desired calyx.</p>

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Flexible and navigable suction ureteral access sheath’s impact on ureteroscope deflection

  • 期刊论文

  • 发表日期：

    2026年2月25日

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  • Lucas B. Vergamini,
  • Bristol B. Whiles,
  • Emily P. Elliott,
  • Jared Starkey,
  • Jill Smith,
  • Mihaela E. Sardiu,
  • Donald Neff,
  • David A. Duchene,
  • Wilson R. Molina

摘要

Introduction

Retrograde intrarenal surgery with flexible ureteroscopes (FURS) is considered gold-standard for treatment of small renal stones, and this procedure often employs the use of a ureteral access sheath. Recently, flexible and navigable suction access sheaths (FANS) have entered the market. FANS are usually bent together with the FURS, which could reduce the maximum deflection angle of the ureteroscope. This study aims to report FURS´ deflection angle loss when employing FANS.

Materials and methods

Active downward deflection was measured in vitro in all possible permutations between different FURS, FANS, and working channel instruments. 8 different flexible ureteroscopes were utilized. FANS (ClearPetra™, Well Lead Medical®, China) included multiple diameters from 10/12 to 13/15 Fr. Two deflection techniques were utilized: 1) Sheath Advancement: deflecting the FURS first and advancing the FANS over the scope, and 2) Ureteroscope Deflection: deflecting both the FANS and scope together by having the FURS tip and the distal tip of the FANS.

Results

A total of 120 measurements were determined. Ureteroscope shaft size was not associated with deflection loss (DL), for all scenarios except when using no fiber and sheath advancement technique (p < 0.05). When controlling for FANS sizes, larger sheaths statistically increased the DL, regardless of technique or working channel occupancy, with all p values < 0.01. In every scenario, DL was higher when using ureteroscope deflection technique than sheath advancement (p < 0.001), with higher difference when the working channel was free without laser fibers (p < 0.05).

Conclusions

While all FURS presented deflection loss when using FANS, smaller FANS diameters were associated with less DL. Preoperative planning with selection of the optimal FANS diameter for the specific FURS utilized may allow for maximal suction without compromising the deflection needed for precise navigation in the collection system to the desired calyx.