Flexible Ureteral Access Sheath with suction -– Does it make a difference in Retrograde intrarenal surgery?

Aim: The objective is to analyse the safety and efficacy of flexible ureteral access sheath (UAS) during retrograde intrarenal surgery in comparison with conventional ureteral access sheath. Primary aim: To compare the stone free rate (SFR), need for auxiliary procedure, complication rate. Secondary aim: To compare the operative time and intraoperative visibility Materials and Methods: Between April and October 2023, prospectively collected data on RIRS using flexible UAS incorporated with suction (Group A, n=50) was matched with retrospective data on RIRS using conventional UAS (Group B, n=50), done by a single surgeon at a single centre. Demographic data and stone characteristics, intra operative and post operative parameters were collected from hospital database. Propensity matched analysis was done between the two groups after matching for stone size, volume and density. Results: The stone free rate (96% vs 92%, p = 0.678) and overall complication rate (22% vs 26%, p= 0.454) was comparable between the two groups. Group A patients had significantly better intraoperative visibility (100% vs 78% Grade 1 visibility, p<0.001), lesser need for auxiliary procedures (4% vs 16%, p=0.046), lesser incidence of post operative fever (4% vs 14%, p= 0.042) as compared to Group B. One patient in Group B required reintervention for steinstrasse after stent removal, while none in Group A required unplanned reintervention. Conclusion: Flexible UAS with suction during RIRS is advantageous due to better intraoperative visibility, lesser need for auxiliary procedures and lesser infectious complications.