The recent innovation of ureteral access sheath (UAS) includes the use of flexible navigable UAS that allows pending into the collecting system and adding suction/evacuation that can improve the efficacy of fragment clearance. This study aimed to report on the experience of using navigable suction-assisted UAS (NS-UAS) for management of kidney stones through a large cohort.
A retrospective analysis was conducted for patients who underwent flexible ureteroscopy for kidney stones using navigable NS-UAS between 2022 and 2025 in a tertiary center. Perioperative outcome data regarding efficacy and safety were described. Univariate and multivariate analysis was conducted for risk factors associated with stone-free rate.
The study included 2284 patients with mean (± SD) age of 48 (± 12.5) years. Half of the patients (49.7%) underwent prior ureteric stent placement. The mean (± SD) stone burden was 13.1 (± 3.7) mm. The mean (± SD) operative time was 95.91 (± 25.2) minutes. Stone basketing was required in 11% of patients. Approximately 70% of patients underwent intraoperative stent placement. Stone-free rate (SFR) at 1-month follow-up was 85.8%. A repeat procedure for stone clearance was required in 12% of the patients. The overall complication incidence was 9.6% with only 1.28% incidence of Clavien-Dindo grade III or IV complications. On multivariate analysis, older age (OR = 0.97 [0.96-0.98]), higher stone burden (OR = 0.45 [0.33-0.62]), and intraoperative stent placement (OR = 0.71 [0.54-0.95]) were associated with lower SFR, while the use of basketing (OR = 2.17 [1.33-3.53]) was associated with higher SFR.
NS-UAS can be used safely and effectively in patients with renal stone disease with low rates of complications and a favorable SFR. Stone basketing may still be necessary during NS-UAS to enhance overall SFR.
Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica. 2026 Jun 29 [Epub]
Ahmed Rabie, Mahmoud Khalil, Zachary Dovey, Moustafa Elsawy, Ahmed Balah, Maida Bada, Mohamed Jabbo, Mohamed Elsaqa, Maurizio Buscarini, Osama Zaytoun
Alexandria University, Egypt; Northwell Health, NY., Department of Surgery, Division of Urology, University of Chicago, IL., Mount Sinai, NY., Alexandria University., Uros Associates' Hospital Sagrada Familia, Barcellona., Hamah National Hospital.