Safety and efficacy of navigable suction-assisted ureteral access sheath for treatment of kidney stones.

BACKGROUND

The recent innovation of ureteral access sheath (UAS) includes the use of flexible navigable UAS that allows pending into the collecting system and adding suction/evacuation that can improve the efficacy of fragment clearance. This study aimed to report on the experience of using navigable suction-assisted UAS (NS-UAS) for management of kidney stones through a large cohort.

METHODS

A retrospective analysis was conducted for patients who underwent flexible ureteroscopy for kidney stones using navigable NS-UAS between 2022 and 2025 in a tertiary center. Perioperative outcome data regarding efficacy and safety were described. Univariate and multivariate analysis was conducted for risk factors associated with stone-free rate.

RESULTS

The study included 2284 patients with mean (± SD) age of 48 (± 12.5) years. Half of the patients (49.7%) underwent prior ureteric stent placement. The mean (± SD) stone burden was 13.1 (± 3.7) mm. The mean (± SD) operative time was 95.91 (± 25.2) minutes. Stone basketing was required in 11% of patients. Approximately 70% of patients underwent intraoperative stent placement. Stone-free rate (SFR) at 1-month follow-up was 85.8%. A repeat procedure for stone clearance was required in 12% of the patients. The overall complication incidence was 9.6% with only 1.28% incidence of Clavien-Dindo grade III or IV complications. On multivariate analysis, older age (OR = 0.97 [0.96-0.98]), higher stone burden (OR = 0.45 [0.33-0.62]), and intraoperative stent placement (OR = 0.71 [0.54-0.95]) were associated with lower SFR, while the use of basketing (OR = 2.17 [1.33-3.53]) was associated with higher SFR.

CONCLUSIONS

NS-UAS can be used safely and effectively in patients with renal stone disease with low rates of complications and a favorable SFR. Stone basketing may still be necessary during NS-UAS to enhance overall SFR.