Flexible and navigable suction ureteral access sheath combined with flexible ureteroscopy for proximal impacted ureter stones: a retrospective case series.

OBJECTIVE

To evaluate the technical feasibility and clinical outcomes of flexible and navigable suction ureteral access sheath (FANS) combined with flexible ureteroscopy (fURS) for proximal impacted ureter stones (PIUS) and identify predictors of residual fragments (RF).

METHODS

This single-center retrospective study included 45 patients with PIUS who underwent FANS-fURS (August 2023-February 2025). The surgical procedure involved FANS deployment, laser lithotripsy, and real-time suction-assisted fragment clearance. Stone-free status (SFS) was assessed at 30 days postoperatively, with Grades B-D defined as RF. Multivariate logistic regression analyzed predictors of RF.

RESULTS

The median age was 55 years (IQR: 41.5-61.5), with 71.1% male. Postoperative SFS were Grade A (40.00%), B (51.11%), C (6.67%), and D (2.22%). Multivariate analysis identified larger sheath size as protective against RF (OR: 0.061, P = 0.025), while larger stone diameter (OR: 1.593, P = 0.031) and higher polyp occupancy within the lumen (OR: 1.919, P = 0.040) increased RF risk. Median operative time was 42 min (IQR: 33.5-65.0).

CONCLUSION

The combination of FANS and fURS demonstrated high efficacy in managing PIUS, achieving favorable stone clearance rates. Sheath size, stone diameter, and polyp occupancy within the lumen are significant predictors of RF, which can help optimize surgical strategy.