Flexible Ureteroscopic Lithotripsy with Pressure-Controlling versus Tip-Flexible Suctioning Ureteral Access Sheath for Renal Stones ≤3 cm: A Randomized Controlled Trial.

INTRODUCTION

This study aimed to compare the safety and efficacy of the pressure-controlling ureteral access sheath (PCUAS) and the tip-flexible suctioning ureteral access sheath (FSUAS) for treating renal stones ≤3 cm.

METHODS

A total of 292 patients with renal stones were prospectively enrolled across 3 centers from June 2022 to October 2024. Participants were randomized into PCUAS and FSUAS groups in a 1:1 ratio. Data compared between groups included demographic information, position placement time, ureteroscopy time, sheath placement time, operation time, stone-free rate, postoperative hospitalization duration, intraoperative complications, and sheath placement success rate.

RESULTS

There was no statistically significant difference in preoperative data between the 2 groups (p > 0.05). Of the 292 patients, ureteral access sheaths (UAS) placement was successful in 268 patients during the first stage, while 19 patients required a second stage after ureteral stent placement. Five patients were converted to percutaneous nephrolithotomy due to failed UAS placement. The PCUAS group had better fever and pain score outcomes than the FSUAS group (p < 0.05). Conversely, the FSUAS group had shorter position placement time, ureteroscopy time, and higher stone-free rate at 1 day and 1 month postoperatively (p < 0.05). Other parameters showed no significant between-group differences.

CONCLUSION

Both PCUAS and FSUAS are safe and effective for the treatment of renal stones ≤3 cm, but each has distinct advantages.