V03-11 Retrograde Intrarenal Surgery With Flexible Tip Vacuum-Assisted Ureteral Access Sheath

You have accessJournal of UrologyUrolithiasis/Endourology (V03)1 May 2024V03-11 RETROGRADE INTRARENAL SURGERY WITH FLEXIBLE TIP VACUUM-ASSISTED URETERAL ACCESS SHEATH Louisa Ho, Cyrus Chehroudi, Sri Sivalingam, and Jorge Gutierrez-Aceves Louisa HoLouisa Ho , Cyrus ChehroudiCyrus Chehroudi , Sri SivalingamSri Sivalingam , and Jorge Gutierrez-AcevesJorge Gutierrez-Aceves View All Author Informationhttps://doi.org/10.1097/01.JU.0001009524.48282.6c.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A ureteral access sheath (UAS) is frequently used when performing retrograde intrarenal surgery (RIRS) to facilitate active stone extraction, maintain lower intrarenal pressure, and improve visibility. A novel flexible tip vacuum-assisted ureteral access sheath (FV-UAS) can be navigated with a flexible ureteroscope within the renal collection system into stone-bearing calyxes, and allows for negative pressure suction while maintaining continuous irrigation. We present, for educational purposes, the advantages and our recommendations for use of this device in a step-by-step surgical video. METHODS: We demonstrate the use of a FV-UAS during a complex RIRS case for a>2 cm lower pole stone burden in a patient felt to be high risk for a percutaneous approach. RESULTS: RIRS was performed in the dorsal lithotomy position. We start with rigid cystoscopy and retrograde pyelography. A 0.038-inch guidewire is introduced in the upper tract as a safety wire, followed by a second guidewire as a working wire. A 11/13 Fr FV-UAS is inserted over the working wire. The FV-UAS is connected to a stone collection bottle, and the system is connected to negative pressure suction. A 7.5 Fr flexible ureteroscope is advanced through the aperture of the rubber end cap into the renal pelvis. A complete inspection of the entire collecting system is performed. Fragmentation is performed with a 200 µm thulium fiber laser, starting with settings of 1 J and 20 Hz and adjusted accordingly. Dust and smaller fragments are vacuumed out the gap between the scope and the sheath. Larger fragments are vacuumed out through the channel of the sheath by withdrawing the scope and allowing the fragments to pass into the side channel. At the end of the procedure, the collecting system is reinspected both visually and fluoroscopically for residual stone fragments. The FV-UAS is removed along with the ureteroscope. A 6 Fr ureteral stent is placed. The patient was discharged home the same day with routine follow up. CONCLUSIONS: A FV-UAS is a promising new device which allows for negative pressure suction to be directly targeted at a stone within a calyx. Smaller dust can be vacuumed out the gap between the scope and the sheath, while larger fragments can be removed through the channel of the sheath by withdrawing the scope intermittently. Use of a FV-UAS has the potential to help urologists increase the efficiency of stone clearance during RIRS without additional auxiliary devices. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e194 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Louisa Ho More articles by this author Cyrus Chehroudi More articles by this author Sri Sivalingam More articles by this author Jorge Gutierrez-Aceves More articles by this author Expand All Advertisement PDF downloadLoading ...