逆行性腎臟內視鏡手術中傳統輸尿管鞘與吸引式輸尿管鞘的應用比較

江亭易¹、 謝佳駤¹、李高漢¹、陳致豪¹、黃冠華¹、邱文祥²

¹外科部泌尿外科，奇美醫學中心；²泌尿外科，新光吳火獅紀念醫院

Comparative Study of Ureteral Access Sheath versus Suction Access Sheath in Retrograde Intrarenal Surgery

Ting-Yi Chiang¹、Chia-Chih Hsieh¹、Kau-Han Lee¹、Zhi-Hao Chen¹、Steven K. Huang¹、Allen W.Chiu²

¹Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan; ²Department of Urology, Shin Kong Wu Ho-Su Memorial Hospital

Purpose:

This study aimed to evaluate and compare the efficacy and safety of the traditional ureteral access sheath (UAS) versus the suction ureteral access sheath (S-UAS) in retrograde intrarenal surgery (RIRS) for the treatment of renal and ureteral stones.

Materials and Methods:

We conducted a retrospective cohort study at a single center, including patients undergoing RIRS from January 2022 to July 2024. Patients were categorized into two groups: those who received the S-UAS and those treated with the traditional UAS. Baseline characteristics, stone-free rates (SFR) immediately and at 1 month postoperatively, operative times, complication rates, and the need for auxiliary procedures were recorded. Patients were subdivided based on stone size (≤15mm and >15mm), stone location, and single versus multiple stones. Statistical analyses were performed to assess differences in outcomes between the two groups.

Results:

A total of 104 patients were included, with 53 in the traditional UAS group and 51 in the S-UAS group. SFR immediately post-op was significantly higher in the S-UAS group (82.0% vs. 60.4%, p=0.016). One-month SFR was also slightly higher in the S-UAS group (85.7% vs. 75.5%, p=0.193), although not statistically significant. Operative times were comparable between the groups (95.9 ± 49.8 vs. 98.4 ± 40.85 minutes, p=0.781). The S-UAS group had fewer auxiliary procedures (5.9% vs. 22.6%, p=0.015) and comparable rates of complications. Subgroup analyses revealed that S-UAS was particularly beneficial in patients with larger stones (>15mm), single stones, and lower pole stones.

Conclusion:

The S-UAS demonstrates a higher immediate SFR and reduces the need for auxiliary procedures compared to traditional UAS in RIRS, suggesting it may enhance efficiency in managing complex or larger renal and ureteral stones. Future studies with larger sample sizes and longer follow-up are warranted to further validate these findings.