Comparative study of flexible navigable suction access sheaths versus conventional ureteral access sheaths in retrograde intrarenal surgery: A prospective single-center evaluation of efficiency and safety

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Purpose The use of suction-enabled ureteral access sheaths during flexible ureteroscopy (fURS) has been proposed to improve procedural efficiency and clinical outcomes of stone management. This study compared novel flexible and navigable suction ureteral access sheaths (FANS-UAS) with conventional ureteral access sheaths (CUAS), focusing on operative parameters, stone-free rates (SFR), and length of hospital stay. Methods In this prospective single-center study, 150 consecutive adult patients undergoing retrograde intrarenal surgery (RIRS) for renal stones in 2024 and 2025 were included. Patients were treated using either FANS-UAS (n = 75) or CUAS (n = 75). Primary endpoints included intraoperative parameters (basket use, operative time, ureteroscopy time, and laser-on time) and SFR. Secondary endpoints included length of hospital stay, re-intervention rate, and 30-day postoperative complications. Statistical analyses were performed using Welch's t-test, chi-square or Fisher's exact test. Results Baseline characteristics were comparable between groups. The FANS-UAS group demonstrated significantly shorter operative time (56.4 ± 20.7 vs. 64.4 ± 22.8 min; p = p < 0.05), ureteroscopy time (43.2 ± 19.6 vs. 51.8 ± 21.8 min; p < 0.05), and laser-on time (21.6 ± 9.8 vs. 25.9 ± 10.9 min; p < 0.05). Basket use was significantly reduced (6.7% vs. 89.3%; p < 0.001). SFR were high and comparable. Hospital stay was shorter with FANS-UAS (1.25 ± 0.82 vs. 1.72 ± 0.83 days; p < 0.001). Complication rates were low and similar. Conclusions FANS-UAS improves operative efficiency and reduces hospitalization without compromising SFR or safety, supporting its use in modern endourological stone management.