The ureteral access sheath (UAS) has been a boon and a bane in flexible ureteroscopy (FURS), with its merits and demerits well established. Its design and dimensions were instrumental in reshaping the way flexible scopes were used and were key adjuncts to establishing retrograde intrarenal surgery (RIRS) as a standard of care in the endourological management of renal stones. With the ever-changing landscape of RIRS over the decades shaped by technological advancements in lasers and flexible scopes, the UAS has also continuously evolved. The utility of suction in endourology has recently changed the way RIRS is performed and is a game changer for FURS outcomes. With strong clinical and experimental evidence to support its use, the UAS has undergone a transformative change in the recent past, with its ability to monitor intrarenal pressure and provide a superior vacuum-cleaner effect that improves the trifecta of RIRS, namely an improved single-stage stone-free rate (SFR), minimise complications, and reduce reinterventions. Our comprehensive review outlines the key clinical and experimental evidence and traces the developments that were key to modifying the traditional UAS into a flexible and navigable suction ureteric access sheath (FANS) and highlights how the design and modifications, in turn, influence the ability to push the boundaries of RIRS.
Diagnostics (Basel, Switzerland). 2024 May 16*** epublish ***
Steffi Kar Kei Yuen, Olivier Traxer, Marcelo Langer Wroclawski, Nariman Gadzhiev, Chu Ann Chai, Ee Jean Lim, Carlo Giulioni, Virgilio De Stefano, Carlotta Nedbal, Martina Maggi, Kemal Sarica, Daniele Castellani, Bhaskar Somani, Vineet Gauhar
SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology AP-HP, Sorbonne University, Tenon Hospital, 75020 Paris, France., Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil., Urology Department, Saint-Petersburg State University Hospital, 197342 St. Petersburg, Russia., Urology Unit, Surgery Department, University Malaya Medical Center, Petaling Jaya 50603, Malaysia., Department of Urology, Singapore General Hospital, Singapore 169608, Singapore., Department of Urology, Casa di Cura Villa Igea, 60127 Ancona, Italy., Urology Unit, Azienda Ospedaliero Universitaria delle Marche, 60121 Ancona, Italy., Department of Maternal Infant and Urological Sciences, Sapienza University of Rome, 00185 Rome, Italy., Department of Urology, Biruni University, 34015 Istanbul, Turkey., Department of Urology, University Hospitals Southampton, NHS Trust, Southampton SO16 6YD, UK., Department of Urology, Ng Teng Fong General Hospital, Singapore 126817, Singapore.