Optimal Deflection Techniques for Flexible and Navigable suction Ureteral Access Sheaths (FANS): a Comparative in Vitro PEARLS Analysis

Overview

Journal World J Urol

Specialty Urology

Date 2024 Oct 30

PMID 39476254

Authors

Alex Lua

Lynnette R L Tan

Frederic Panthier

Alba Sierra

Eugenio Ventimiglia

Catalina Solano

Vincent De Coninck

Steffi Kar Kei Yuen

Vineet Gauhar

Olivier Traxer

Etienne Xavier Keller

Jia-Lun Kwok

Affiliations

Soon will be listed here.

Abstract

Purpose: Flexible and navigable suction ureteral access sheaths (FANS) have been introduced without current evidence on how to optimize deflection. Aim was to evaluate in vitro deflection angles with 2 different FANS techniques-sheath advancement and ureteroscope deflection; and effects of sheath size-ureteroscope combinations.

Methods: We evaluated in vitro deflection angles of 10/12Fr, 11/13Fr and 12/14Fr FANS (Hunan Reborn Medical Co. Ltd) with six single-use flexible ureteroscopes (Pusen Uscope 7.5Fr, OTU WiScope 7.5Fr, OTU WiScope 8.6Fr, Innovex EU-scope 8.7Fr, Red Pine RP-U-C12 8.7Fr and Boston Scientific Lithovue 9.5Fr). Two deflection techniques were tested: (1) sheath advancement-advancing the sheath forward over a maximally deflected ureteroscope, and (2) ureteroscope deflection-maximally deflecting the ureteroscope from various starting positions relative to tip of the sheath.

Results: Intra and inter-scope comparisons of maximum deflection angles were significantly different (all ANOVA p < 0.01). Largest maximum angles for all ureteroscopes were with the sheath advancement technique (range 218°-277°), and second largest for most scopes using the ureteroscope deflection technique at tip (range 111°-212°), mostly deviating from manufacturer specifications (range 270°-275°). 10/12Fr and 11/13Fr sheath sizes were more flexible than 12/14Fr. Largest angles were with 11/13Fr sheath-OTU8.6Fr/Innovex8.7Fr combinations.

Conclusion: Optimal deflection with FANS is achieved using either a sheath advancement technique, or ureteroscope deflection technique at tip. Despite using these optimized techniques, deflection angles specified by manufacturers seem hardly achievable. The sheath advancement technique and 11/13Fr sheath-OTU8.6Fr/Innovex8.7Fr combinations may be better suited for lower pole situations. Urologists should be aware of these differences and apply the findings to their FANS technique.

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References

Geraghty R, Jones P, Somani B . Worldwide Trends of Urinary Stone Disease Treatment Over the Last Two Decades: A Systematic Review. J Endourol. 2017; 31(6):547-556. DOI: 10.1089/end.2016.0895. View

Heers H, Stay D, Wiesmann T, Hofmann R . Urolithiasis in Germany: Trends from the National DRG Database. Urol Int. 2021; 106(6):589-595. PMC: 9248299. DOI: 10.1159/000520372. View

Candela L, Ventimiglia E, Solano C, Chicaud M, Kutchukian S, Panthier F . Endoscopic Conservative Treatment of Upper Urinary Tract Urothelial Carcinoma with a Thulium Laser: A Systematic Review. J Clin Med. 2023; 12(15). PMC: 10419594. DOI: 10.3390/jcm12154907. View

Jahrreiss V, Ripa F, Cerrato C, Nedbal C, Pietropaolo A, Somani B . Comparison of ureteoroscopy and laser stone fragmentation between Holmium: YAG laser with MOSES versus non-MOSES technology: a prospective single-center propensity score-matched analysis using similar laser settings. Ther Adv Urol. 2024; 16:17562872241272974. PMC: 11334132. DOI: 10.1177/17562872241272974. View

Yuen S, Traxer O, Wroclawski M, Gadzhiev N, Chai C, Lim E . Scoping Review of Experimental and Clinical Evidence and Its Influence on Development of the Suction Ureteral Access Sheath. Diagnostics (Basel). 2024; 14(10). PMC: 11120421. DOI: 10.3390/diagnostics14101034. View

Zhu Z, Cui Y, Zeng F, Li Y, Chen Z, Hequn C . Comparison of suctioning and traditional ureteral access sheath during flexible ureteroscopy in the treatment of renal stones. World J Urol. 2018; 37(5):921-929. DOI: 10.1007/s00345-018-2455-8. View

Gauhar V, Somani B, Heng C, Gauhar V, Chew B, Sarica K . Technique, Feasibility, Utility, Limitations, and Future Perspectives of a New Technique of Applying Direct In-Scope Suction to Improve Outcomes of Retrograde Intrarenal Surgery for Stones. J Clin Med. 2022; 11(19). PMC: 9570998. DOI: 10.3390/jcm11195710. View

Sur R, Agrawal S, Eisner B, Haleblian G, Ganpule A, Sabnis R . Initial Safety and Feasibility of Steerable Ureteroscopic Renal Evacuation: A Novel Approach for the Treatment of Urolithiasis. J Endourol. 2022; 36(9):1161-1167. PMC: 9422793. DOI: 10.1089/end.2021.0759. View

Yu W, Jhang J, Jiang Y, Kuo H . Pelvic floor muscle pain is associated with higher symptom scores and bladder pain perception in women with interstitial cystitis and bladder pain syndrome. World J Urol. 2024; 43(1):9. DOI: 10.1007/s00345-024-05366-7. View

10.

Gauhar V, Traxer O, Castellani D, Ragoori D, Heng C, Chew B . A Feasibility Study on Clinical Utility, Efficacy and Limitations of 2 Types of Flexible and Navigable Suction Ureteral Access Sheaths in Retrograde Intrarenal Surgery for Renal Stones. Urology. 2023; 178:173-179. DOI: 10.1016/j.urology.2023.05.032. View

11.

Chen Y, Xi H, Yu Y, Cheng X, Yang H, Deng W . Flexible ureteroscopy with novel flexible ureteral access sheath versus mini-percutaneous nephrolithotomy for treatment of 2-3 cm renal stones. Int J Urol. 2023; 31(3):281-286. PMC: 11524096. DOI: 10.1111/iju.15347. View

12.

Uleri A, Long Depaquit T, Farre A, Cornu J, Schwartzmann I, Castellani D . Thulium Fiber Versus Holmium:Yttrium-aluminum-garnet Laser for Endoscopic Enucleation of the Prostate: A Systematic Review and Meta-analysis. Eur Urol Focus. 2024; 10(6):914-921. DOI: 10.1016/j.euf.2024.06.005. View

13.

De Coninck V, Keller E, Somani B, Giusti G, Proietti S, Rodriguez-Socarras M . Complications of ureteroscopy: a complete overview. World J Urol. 2019; 38(9):2147-2166. DOI: 10.1007/s00345-019-03012-1. View

14.

Lildal S, Andreassen K, Jung H, Pedersen M, Osther P . Evaluation of ureteral lesions in ureterorenoscopy: impact of access sheath use. Scand J Urol. 2018; 52(2):157-161. DOI: 10.1080/21681805.2018.1430705. View

15.

Ye T, Shi X, Yu Y, Yu G, Xu B, Zhang Z . Ultrasound-guided renal artery balloon catheter occluded hybrid partial nephrectomy (UBo-HPN) with branch renal artery occlusion: a single arm trial. World J Urol. 2024; 42(1):570. PMC: 11464546. DOI: 10.1007/s00345-024-05263-z. View

16.

Fang L, Xie G, Zheng Z, Liu W, Zhu J, Huang T . The Effect of Ratio of Endoscope-Sheath Diameter on Intrapelvic Pressure During Flexible Ureteroscopic Lasertripsy. J Endourol. 2019; 33(2):132-139. DOI: 10.1089/end.2018.0774. View

17.

De Coninck V, Somani B, Tarik Sener E, Emiliani E, Corrales M, Juliebo-Jones P . Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review. J Clin Med. 2022; 11(17). PMC: 9456781. DOI: 10.3390/jcm11175128. View

18.

Wang D, Han Z, Bi Y, Ma G, Xu G, Hu Q . Comparison of intrarenal pressure between convention and vacuum-assisted ureteral access sheath using an ex vivo porcine kidney model. World J Urol. 2022; 40(12):3055-3060. DOI: 10.1007/s00345-022-04149-2. View

19.

De Coninck V, Keller E, Rodriguez-Monsalve M, Audouin M, Doizi S, Traxer O . Systematic review of ureteral access sheaths: facts and myths. BJU Int. 2018; 122(6):959-969. DOI: 10.1111/bju.14389. View

20.

Sener T, Tanidir Y, Hamri S, Sever I, Ozdemir B, Al-Humam A . Effects of flexible ureteroscopy on renal blood flow: a prospective evaluation. Scand J Urol. 2018; 52(3):213-218. DOI: 10.1080/21681805.2018.1437770. View