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Purpose <p>To determine recommendable settings of irrigation pressure, suction pressure, and the ratio of endoscope-sheath diameter (RESD) for safe and efficient stone removal when using a flexible and navigable suction ureteral access sheath (FANS-UAS) in retrograde intrarenal surgery (RIRS).</p> Methods <p>An ex vivo porcine kidney model with an artificial calcium oxalate stone was used. Different RESD values (0.68, 0.75, 0.86, and 0.95) were evaluated under different combinations of irrigation pressure (100, 200, and 300 mmHg) and suction pressure (100, 200, 300, and 400 mmHg). Stone pull-out time (POT), measured ten times for each setting to compare stone removal efficiency, was the primary endpoint. Intrarenal pressure (IRP), measured for 1&#xa0;min with a safety cutoff value of 30 mmHg, was the safety endpoint.</p> Results <p>Higher irrigation pressure significantly shortened stone POT (<i>p</i> &lt; 0.05), with strongest correlation at RESD 0.75. In contrast, suction pressure over 200 mmHg improved POT versus 100mmHg but showed no graded benefit beyond 200mmHg. At matched settings, POT was generally shorter at RESD 0.86 than 0.75. IRP remained under 30 mmHg across most pressure combinations at RESD 0.68, 0.75, and 0.86, while exceeded safe levels at RESD 0.95 with irrigation pressure over 200 mmHg.</p> Conclusion <p>For faster stone removal using FANS-UAS, increasing irrigation pressure with proper RESD is crucial. Also, maintaining appropriate suction pressure is important to keep safe IRP range. These results provide recommendable in-vitro guidance to balance efficiency and IRP control when using FANS-UAS in RIRS.</p>

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Pressure and sheath settings in a flexible suction ureteral access sheath: in-vitro assessment for retrograde intrarenal surgery

  • 期刊论文

  • 发表日期：

    2026年4月11日

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  • Sang Won So,
  • Jose Carlo R. Elises,
  • Fahad Alzahrani,
  • Omar Sulaiman,
  • Hyomyoung Lee,
  • Paul R. Villegas,
  • Ching-Heung Yen,
  • Mohammed Almujhim,
  • Sung Yong Cho

摘要

Purpose

To determine recommendable settings of irrigation pressure, suction pressure, and the ratio of endoscope-sheath diameter (RESD) for safe and efficient stone removal when using a flexible and navigable suction ureteral access sheath (FANS-UAS) in retrograde intrarenal surgery (RIRS).

Methods

An ex vivo porcine kidney model with an artificial calcium oxalate stone was used. Different RESD values (0.68, 0.75, 0.86, and 0.95) were evaluated under different combinations of irrigation pressure (100, 200, and 300 mmHg) and suction pressure (100, 200, 300, and 400 mmHg). Stone pull-out time (POT), measured ten times for each setting to compare stone removal efficiency, was the primary endpoint. Intrarenal pressure (IRP), measured for 1 min with a safety cutoff value of 30 mmHg, was the safety endpoint.

Results

Higher irrigation pressure significantly shortened stone POT (p < 0.05), with strongest correlation at RESD 0.75. In contrast, suction pressure over 200 mmHg improved POT versus 100mmHg but showed no graded benefit beyond 200mmHg. At matched settings, POT was generally shorter at RESD 0.86 than 0.75. IRP remained under 30 mmHg across most pressure combinations at RESD 0.68, 0.75, and 0.86, while exceeded safe levels at RESD 0.95 with irrigation pressure over 200 mmHg.

Conclusion

For faster stone removal using FANS-UAS, increasing irrigation pressure with proper RESD is crucial. Also, maintaining appropriate suction pressure is important to keep safe IRP range. These results provide recommendable in-vitro guidance to balance efficiency and IRP control when using FANS-UAS in RIRS.