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Abstract

Objectives:

To compare the safety and effectiveness of a novel flexible vacuum-assisted ureteral access sheath (FV-UAS) and traditional ureteral access sheath (UAS) in simulating retrograde intrarenal surgery (RIRS).

Materials and Methods:

A manometric model was established in porcine kidneys to observe the change in intrarenal pressure (IRP) in the FV-UAS and traditional UAS groups at different irrigation fluid velocities of 30, 50, 80, and 100 mL/min. Establish a kidney stone model (with 0.2 g, dry, ≤5 mm stones) to simulate RIRS. A total of 20 porcine kidneys were randomly numbered from 1 to 20 (FV-UAS group, 1 − 10; traditional UAS group, 11 − 20). The stone volume clearance rate and operation time were compared between the two groups. (“ $S t o n e v o l u m e c l e a r a n c e r a t e = (1 - \frac{R e s i d u a l s t o n e v o l u m e}{P r e o p e r a t i v e s t o n e v o l u m e}) \times 100 %$ ”). Stone volume was obtained by CT pre- and postoperatively.

Results:

FV-UAS can follow flexible ureteroscopy (f-URS) to cross the ureteropelvic junction (UPJ) and into the renal pelvis and calices. FV-UAS can actively make IRP <10 cmH₂O by adjusting the negative values at different irrigation fluid velocities. The mean residual stone volume of the FV-UAS vs traditional UAS groups was 33.7 vs 92.5 mm³ (p = 0.017). The mean stone volume clearance rates of the FV-UAS vs traditional UAS groups were 98.5% and 95.9%, respectively (p = 0.017). Seven cases achieved complete stone-free status in the FV-UAS group. All patients had residual fragments postoperatively in the traditional UAS group.

Conclusions:

FV-UAS can follow f-URS to cross the UPJ and into the renal pelvis and calices, avoiding the interference of UPJ in controlling IRP. FV-UAS can actively control the IRP to be reduced to the desired range by adjusting the negative value under any irrigation fluid velocity. FV-UAS close to the stone can achieve complete stone-free status in RIRS.

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References

Rodríguez-Monsalve Herrero

, Doizi

, Keller

, De Coninck

, Traxer

. Retrograde intrarenal surgery: An expanding role in treatment of urolithiasis. Asian J Urol, 2018; 5:264–273.

Chung

, Kim

, Min

, et al. Changing trends in the treatment of nephrolithiasis in the real world. J Endourol, 2019; 33:248–253.

Doizi

Intrarenal pressure: What is acceptable for flexible ureteroscopy and percutaneous nephrolithotomy?. Eur Urol Focus, 2021; 7:31–33.

Guven

, Yigit

, Tuncel

, et al. Retrograde intrarenal surgery of renal stones: A critical multi-aspect evaluation of the outcomes by the Turkish Academy of Urology Prospective Study Group (ACUP Study). World J Urol, 2021; 39:549–554.

Hinman

, Redewill

. Pyelovenous back flow. JAMA, 1926; 87:1287–1293.

Tokas

, Herrmann

, Skolarikos

, Nagele

. Pressure matters: Intrarenal pressures during normal and pathological conditions, and impact of increased values to renal physiology. World J Urol, 2019; 37:125–131.

Kang

, Son

, Jeong

, Cho

. Clearance rates of residual stone fragments and dusts after endoscopic lithotripsy procedures using a holmium laser: 2-year follow-up results. World J Urol, 2016; 34:1591–1597.

Hein

, Miernik

, Wilhelm

, et al. Clinical significance of residual fragments in 2015: Impact, detection, and how to avoid them. World J Urol, 2016; 34:771–778.

Prezioso

, Barone

, Di Domenico

, Vitale

. Stone residual fragments: A thorny problem. Urologia, 2019; 86:169–176.

10.

Emmott

, Brotherhood

, Paterson

, Lange

, Chew

. Complications, re-intervention rates, and natural history of residual stone fragments after percutaneous nephrolithotomy. J Endourol, 2018; 32:28–32.

11.

Brain

, Geraghty

, Lovegrove

, Yang

, Somani

. Natural history of post-treatment kidney stone fragments: A systematic review and meta-analysis. J Urol, 2021; 206:526–538.

12.

Tonyali

Suctioning ureteral access sheath use in flexible ureteroscopy might decrease operation time and prevent infectious complications. World J Urol, 2019; 37:393–394.

13.

Rehman

, Monga

, Landman

, et al. Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology, 2003; 61:713–718.

14.

Kourambas

, Byrne

, Preminger

. Does a ureteral access sheath facilitate ureteroscopy?. J Urol, 2001; 165:789–793.

15.

Oratis

, Subasic

, Hernandez

, Bird

, Eisner

. A simple fluid dynamic model of renal pelvis pressures during ureteroscopic kidney stone treatment. PLoS One, 2018; 13:e0208209.

16.

Shu

, Hua

, Xie

. An irrigation system for noninvasively estimating intrarenal pressure during flexible ureteroscopy. Int J Med Robot, 2021; 17:e2306.

17.

Hein

, Schoenthaler

, Wilhelm

, et al. Novel biocompatible adhesive for intrarenal embedding and endoscopic removal of small residual fragments after minimally invasive stone treatment in an ex vivo porcine kidney model: Initial evaluation of a prototype. J Urol, 2016; 196:1772–1777.

18.

Lazarus

, Kaestner

Novel syphon ureteral access sheath has potential to improve renal pressures and irrigant flow. BJU Int 2021 Sep 8.

19.

Zeng

, Wang

, Zhang

, Wan

. Modified access sheath for continuous flow ureteroscopic lithotripsy: A preliminary report of a novel concept and technique. J Endourol, 2016; 30:992–996.

20.

Zhu

, Cui

, Zeng

, Li

, Chen

, Hequn

. Comparison of suctioning and traditional ureteral access sheath during flexible ureteroscopy in the treatment of renal stones. World J Urol, 2019; 37:921–929.

21.

Tapiero

, Ghamarian

, Clayman

. A technique to flush out stone fragments through a ureteral access sheath during retrograde intrarenal surgery. J Endourol, 2019; 5:161–163.

22.

Ghani

, Wolf

. What is the stone-free rate following flexible ureteroscopy for kidney stones?. Nat Rev Urol, 2015; 12:281–288.

23.

Hein

, Schoeb

, Grunwald

, et al. Viability and biocompatibility of an adhesive system for intrarenal embedding and endoscopic removal of small residual fragments in minimally-invasive stone treatment in an in vivo pig model. World J Urol, 2018; 36:673–680.

24.

Schoeb

, Schoenthaler

, Schlager

, et al. New for old-coagulum lithotomy vs a novel bioadhesive for complete removal of stone fragments in a comparative study in an ex vivo porcine model. J Endourol, 2017; 31:611–616.

25.

F-C

, Chou

Y-J

. Rolling and lifting probabilities for sediment entrainment. J Hydraul Eng, 2003; 129:2(110).

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Novel Flexible Vacuum-Assisted Ureteral Access Sheath Can Actively Control Intrarenal Pressure and Obtain a Complete Stone-Free Status

Abstract

Objectives:

Materials and Methods:

Results:

Conclusions:

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References

Supplementary Material