Retrograde intrarenal surgery (RIRS) is a preferred treatment for renal stones, yet challenges such as kidney movement due to respiration hinder surgical precision and outcomes. The introduction of flexible and navigable suction ureteral access sheaths (FANS) and novel techniques like gated respiration aim to improve stone-free rates (SFR) and reduce complications. This study evaluates the impact of gated respiration on perioperative outcomes in RIRS with FANS.
A prospective multicenter study enrolled 562 adult patients undergoing RIRS with FANS under general anesthesia. Patients were divided into two groups: non-gated respiration (Group 1) and gated respiration (Group 2). Stone-free status (SFS) was assessed at 30 days using NCCT scans. SFS was defined as follows: grade A, zero fragments; grade B, a single fragment ≤ 2 mm; grade C, a single fragment 2.1-4 mm; and grade D, single/multiple fragments > 4 mm. Procedural efficiency, perioperative complications, and surgeon-reported outcomes were compared.
Patients in Group 2 had significantly higher zero residual fragment (Grade A) rates (64.2% vs. 59%) and overall SFR (Grade A + B: 98.3% vs. 91.3%, p = 0.001). Gated respiration improved sheath navigation (91.2% vs. 85.1%, p = 0.038) and visibility during lithotripsy (p = 0.004), while reducing complications like mild bleeding due to sheath movement (3.1% vs. 11.2%, p < 0.001). Logistic regression identified gated respiration as a significant predictor of SFS (OR 6.26, 95% CI 2.28-22.6, p < 0.001).
Gated respiration synergistically enhances the efficacy of FANS in RIRS, improving SFR, procedural safety, and surgeon experience. This study highlights the importance of respiratory control as an adjunct to RIRS, emphasizing the need for interdisciplinary collaboration between surgical and anesthesiology teams.
World journal of urology. 2025 Feb 08*** epublish ***
Ee Jean Lim, Bhaskar Kumar Somani, Mehmet Ilker Gokce, Chin Tiong Heng, Ashish Ranjan Satapathy, Jose Ivan Robles, Tsung Wen Chong, Khi Yung Fong, Daniele Castellani, Naeem Bhojani, Hatem Kamkoum, Nariman Gadzhiev, Vigen Malkhasyan, Von Vee Ng, Saeed Bin Hamri, Steffi Kar-Kei Yuen, Thomas R W Herrmann, Oliver Traxer, Vineet Gauhar
Department of Urology, Singapore General Hospital, Academia Level 5, 20 College Rd, Singapore, 169856, Singapore. ., University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK., Department of Urology, Ankara University School of Medicine, Ankara, Turkey., Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore., Department of Anaesthesiology, Ng Teng Fong General Hospital, Singapore, Singapore., Torres Hospital Universitario, Monterrey, Nuevo León, México., Department of Urology, Singapore General Hospital, Academia Level 5, 20 College Rd, Singapore, 169856, Singapore., Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore., Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy., Division of Urology, University of Montreal, Centre Hospitalier de l'Université de Montréal, 900 St Denis R04.442, Montreal, QC, H2X, Canada., Aisha bint Hamad al-Attiyah Hospital (Hamad Medical Corporation), Tinbak, Qatar., Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia., Urology Unit, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia., Department of Anaesthesiology, Singapore General Hospital, Academia Level 5, 20 College Rd, Singapore, 169856, Singapore., Division of Urology, Department of Surgery, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia., Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland., Department of Urology Hôpital Tenon, Sorbonne University, Paris, France.