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Purpose <p>To evaluate intrarenal pressure (IRP) during flexible and navigable suction ureteral access sheath (FANS)-assisted retrograde intrarenal surgery (RIRS), and to identify clinical factors influencing increased IRP.</p> Methods <p>This retrospective study included 30 consecutive patients who underwent FANS-assisted RIRS using the LithoVue™ Elite ureteroscope (Boston Scientific, Marlborough, USA) at two Japanese centers between October 2024 and May 2025. Two types of 12/14 Fr FANS, Clear Petra™ (Wellead Medical, Guangzhou, China) and NOVAGATE™ (Dornier MedTech, Zhejiang, China) were utilized. IRP was evaluated during the lithotripsy phase. Various IRP metrics were analyzed, including the median, maximum, time-weighted mean, percentage of time above thresholds (&gt; 20, &gt; 30, and &gt; 40&#xa0;mmHg), and area under the curve (AUC). Factors related to % time &gt; 30&#xa0;mmHg were assessed, and temporal changes in IRP were compared across four equal surgical intervals.</p> Results <p>The median % time &gt; 20, &gt; 30, and &gt; 40&#xa0;mmHg were 22.7% (IQR 5–52.1), 3.31% (0.8–13.5), and 0.01% (0–3.3), respectively. % time &gt; 30&#xa0;mmHg was significantly greater when the FANS tip was positioned at the ureteropelvic junction than within the renal pelvis (10.4 vs 1.2%, p = 0.02) and in staghorn cases (11.3 vs 1.1%, p = 0.01). No significant differences were observed across the four surgical intervals (p = 0.85). No postoperative febrile urinary tract infections occurred. There were no cases of postoperative febrile urinary tract infection.</p> Conclusions <p>FANS-assisted RIRS allowed real-time monitoring and overall maintenance of low intrarenal pressure. Staghorn calculi and sheath tip position were associated with pressure elevation. The generalizability is limited as only 12/14 Fr sheaths were included.</p>

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Intrarenal pressure during the flexible and navigable suction ureteral access sheath-assisted retrograde intrarenal surgery: a two-center study

  • 期刊论文

  • 发表日期：

    2025年11月2日

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  • Sotaro Kayano,
  • Takafumi Yanagisawa,
  • Ken Shibata,
  • Eriko Nishi,
  • Yuji Yata,
  • Keiichiro Miyajima,
  • Naoki Fujisawa,
  • Yuka Yasuda,
  • Shigetoshi Maiya,
  • Tetsuo Shinozaki,
  • Steffi Kar Kei Yuen,
  • Tatsuya Simomura,
  • Takahiro Kimura

摘要

Purpose

To evaluate intrarenal pressure (IRP) during flexible and navigable suction ureteral access sheath (FANS)-assisted retrograde intrarenal surgery (RIRS), and to identify clinical factors influencing increased IRP.

Methods

This retrospective study included 30 consecutive patients who underwent FANS-assisted RIRS using the LithoVue™ Elite ureteroscope (Boston Scientific, Marlborough, USA) at two Japanese centers between October 2024 and May 2025. Two types of 12/14 Fr FANS, Clear Petra™ (Wellead Medical, Guangzhou, China) and NOVAGATE™ (Dornier MedTech, Zhejiang, China) were utilized. IRP was evaluated during the lithotripsy phase. Various IRP metrics were analyzed, including the median, maximum, time-weighted mean, percentage of time above thresholds (> 20, > 30, and > 40 mmHg), and area under the curve (AUC). Factors related to % time > 30 mmHg were assessed, and temporal changes in IRP were compared across four equal surgical intervals.

Results

The median % time > 20, > 30, and > 40 mmHg were 22.7% (IQR 5–52.1), 3.31% (0.8–13.5), and 0.01% (0–3.3), respectively. % time > 30 mmHg was significantly greater when the FANS tip was positioned at the ureteropelvic junction than within the renal pelvis (10.4 vs 1.2%, p = 0.02) and in staghorn cases (11.3 vs 1.1%, p = 0.01). No significant differences were observed across the four surgical intervals (p = 0.85). No postoperative febrile urinary tract infections occurred. There were no cases of postoperative febrile urinary tract infection.

Conclusions

FANS-assisted RIRS allowed real-time monitoring and overall maintenance of low intrarenal pressure. Staghorn calculi and sheath tip position were associated with pressure elevation. The generalizability is limited as only 12/14 Fr sheaths were included.