Department of Urology, Changhai Hospital, First Affiliated Hospital of Naval Medical University, Shanghai, China.
World J Urol. 2024 Nov 5;42(1):626. doi: 10.1007/s00345-024-05325-2.
This study aims to evaluate the efficacy of tip-flexible suctioning ureteral access sheath (TFS-UAS) compared to traditional ureteral access sheath (T-UAS) in flexible ureteroscopic lithotripsy (FURL) for unilateral upper urinary tract calculi.
The study retrospectively compared outcomes from 103 cases using TFS-UAS and 138 using T-UAS treated with FURL for unilateral upper urinary tract calculi from January to October 2023. Assessed parameters included patient demographics, stone characteristics, preoperative urine cultures, ureteral pre-stenting, comorbidities, procedure time, stone-free rate (SFR), utilization of stone retrieval baskets, and postoperative Systemic Inflammatory Response Syndrome (SIRS) rates. The maximum angle of deflection was also measured when the flexible ureteroscope was located in different parts of the TFS-UAS with different diameters in vitro.
The TFS-UAS group achieved a higher Immediate SFR (76.70% vs. 63.77%, p = 0.031) and final SFR (89.32% vs. 73.91%, p = 0.003) than the T-UAS group, especially in the lower calyx stones (80.00% vs. 41.18%, p = 0.018) and upper urinary tract calculi with a cumulative diameter of 2 cm or larger (68.97% vs. 42.11%, p = 0.029). Notably, TFS-UAS with a 10 French (F) inside diameter size achieved a higher SFR (88.57% vs. 70.59%, p = 0.041) and a greater deflection angle than the 12.5 F inside diameter size. No significant variations were observed in the operative duration, hospitalization duration and the occurrence of SIRS between the compared cohorts.
TFS-UAS significantly improves SFR in FURL treatment of unilateral upper urinary tract calculi, particularly for stones located in the lower calyx or with a cumulative diameter of 2 cm or greater, compared to T-UAS.
本研究旨在评估尖端灵活抽吸输尿管接入鞘（TFS-UAS）与传统输尿管接入鞘（T-UAS）在单侧上尿路结石的软性输尿管镜碎石术（FURL）中的疗效。
本研究回顾性比较了 2023 年 1 月至 10 月期间，103 例采用 TFS-UAS 和 138 例采用 T-UAS 行 FURL 治疗单侧上尿路结石的患者的临床资料。评估参数包括患者人口统计学特征、结石特征、术前尿液培养、输尿管预置管、合并症、手术时间、无石率（SFR）、结石取石篮的使用情况以及术后全身炎症反应综合征（SIRS）的发生率。还在体外测量了柔性输尿管镜在不同直径的 TFS-UAS 的不同部位时的最大偏转角。
TFS-UAS 组即刻 SFR（76.70%比 63.77%，p=0.031）和最终 SFR（89.32%比 73.91%，p=0.003）均高于 T-UAS 组，尤其是在下盏结石（80.00%比 41.18%，p=0.018）和累积直径 2cm 或更大的上尿路结石（68.97%比 42.11%，p=0.029）。值得注意的是，10Fr 内直径的 TFS-UAS 获得了更高的 SFR（88.57%比 70.59%，p=0.041）和更大的偏转角，优于 12.5Fr 内直径的 TFS-UAS。比较组之间的手术时间、住院时间和 SIRS 的发生无显著差异。
与 T-UAS 相比，TFS-UAS 可显著提高 FURL 治疗单侧上尿路结石的 SFR，尤其是对于下盏结石或累积直径 2cm 或更大的结石。
