Balancing The Ratio Between Flexible Renoscope And Different Ureteral Access Sheath Combinations and Comparing Their Effects on Post-Operative Outcome

Authors

DOI:

https://doi.org/10.36283/ziun-pjmd15-2/012

Keywords:

Hydronephrosis , Computed Tomography (CT) , kidney stones, flexible ureteroscopy, Retrograde Intrarenal Surgery (RIRS), renal st

Abstract

Background: To evaluate the efficacy of the ratio of FURS and ureteral access sheath diameter, aiming to identify the most appropriate combination for improved post-operative outcomes

Method: Prospective, cross - sectional study conducted at Tabba kidney Institute. 300 patients were enrolled from August 2025 till October 2025. Patients were randomly classified in three groups on basis of ureteral access sheath sizes and endoscope to sheath ratio. Group A (ureteral access sheath 9/11) and group B (ureteral access sheath 10/12) group 3 (sheath 11/13) with FURS size of 8.6 Fr. Peri-operative demographics detail, pre-operative stone size, location, intra-operative and post-operative complications, fluoroscopy time and stone free rates on follow up were compared. SPSS-23 was used to analyze data.

Results: There were 70.40 % males in Group A, 60.40% in group B and 65.30% in group C and 29.60%, 39.60% and 34.70% females in groups A, B and C respectively. There was highest operative time in Group A (70.3 ± 20.9 min) p value of 0.023 with equivocal stone sizes in all groups.

Conclusion: The combination of 11/13Fr ureteral access sheath with an 8Fr flexible URS offers ideal balance for optimal stone clearance by providing remarkable visibility and maintaining adequate intra-pelvic pressure. This approach effectively reduces the risk of postoperative complications and minimizes the risk of ureteric injury promoting safe surgical outcomes.

Author Biographies

  • Muhammad Faizan Shaikh, Tabba Kidney Institute

    Postgraduate Trainee, Department of Urology

  • Sherjeel Saulat, Tabba Kidney Institute

    Head of the Department, Department of Nephrology

  • Jahanzeb Shaikh, Tabba Kidney Institute

    Consultant, Department of Urology

  • Umber Rasheed, Tabba Kidney Institute

    senior registrar

  • Subhan Ahmed Sajjad, Tabba Kidney Institute

    Postgraduate Trainee, Department of Urology

  • Ashba Mushtaque, Tabba Kidney Institute

    Senior Registrar, Department of Urology

  • Aamir Khan, Tabba Kidney Institute

    Postgraduate Trainee, Department of Urology

References

1. Spiardi R, Goldfarb DS, Tasian GE. Role of climate change in urologic health: kidney stone disease. European urology focus. 2023 Nov 1;9(6):866-8.

2. Bhanot R, Jones P, Somani B. Minimally invasive surgery for the treatment of ureteric stones–state-of-the-art review. Research and reports in urology. 2021 May 6:227-36.

3. He M, Dong Y, Cai W, Cai J, Xie Y, Yu M, Li C, Wen L. Recent advances in the treatment of renal stones using flexible ureteroscopys. International Journal of Surgery. 2024 Jul 1;110(7):4320-8.

4. Tzelves L, Geraghty RM, Hughes T, Juliebø-Jones P, Somani BK. Innovations in kidney stone removal. Research and reports in urology. 2023 Dec 31:131-9.

5. Gauhar, V., Chew, B.H., Traxer, O., Tailly, T., Emiliani, E., Inoue, T., Tiong, H.C., Chai, C.A., Lakmichi, M.A., Tanidir, Y. and Bin Hamri, S., 2023. Indications, preferences, global practice patterns and outcomes in retrograde intrarenal surgery (RIRS) for renal stones in adults: results from a multicenter database of 6669 patients of the global FLEXible ureteroscopy Outcomes Registry (FLEXOR). World journal of urology, 41(2), pp.567-574.

6. Lim EJ, Traxer O, Madarriaga YQ, Castellani D, Fong KY, Chan VW, Tur AB, Pietropaolo A, Ragoori D, Shrestha A, Vaddi CM. Outcomes and lessons learnt from practice of retrograde intrarenal surgery (RIRS) in a paediatric setting of various age groups: a global study across 8 centres. World Journal of Urology. 2022 May;40(5):1223-9.

7. Law YX, Teoh JY, Castellani D, Lim EJ, Chan EO, Wroclawski M, Pirola GM, Giulioni C, Rubilotta E, Gubbioti M, Scarcella S. Role of pre-operative ureteral stent on outcomes of retrograde intra-renal surgery (RIRS): systematic review and meta-analysis of 3831 patients and comparison of Asian and non-Asian cohorts. World Journal of Urology. 2022 Jun;40(6):1377-89.

8. Shu C, Liu J. Status study of clinical application of ureteral access sheath in urology: a narrative review. Translational Andrology and Urology. 2025 Feb 25;14(2):441.

9. Pauchard F, Ventimiglia E, Corrales M, Traxer O. A practical guide for intra-renal temperature and pressure management during RIRS: what is the evidence telling us. Journal of Clinical Medicine. 2022 Jun 15;11(12):3429.

10. Bozzini G, Bevilacqua L, Besana U, Calori A, Pastore A, Otero JR, Macchi A, Broggini P, Breda A, Gozen A, Inzillo R. Ureteral access sheath-related injuries vs. post-operative infections. Is sheath insertion always needed? A prospective randomized study to understand the lights and shadows of this practice. Actas Urológicas Españolas (English Edition). 2021 Nov 1;45(9):576-81.

11. Shi J, Huang T, Song B, Liu W, Cheng Y, Fang L. The optimal ratio of endoscope-sheath diameter with negative-pressure ureteral access sheath: an in vitro research. World Journal of Urology. 2024 Mar 7;42(1):122.

12. Song B, Cheng Y, Lu Y, Rong H, Huang T, Shi J, Fang L. Factors affecting the intraoperative calculi excretion during flexible ureteroscopy lithotripsy: an in vitro analysis. World Journal of Urology. 2024 Mar 9;42(1):130.

13. Tokas T, Tzanaki E, Nagele U, Somani BK. Role of intrarenal pressure in modern day endourology (Mini-PCNL and Flexible URS): a systematic review of literature. Current Urology Reports. 2021 Oct;22(10):52.

14. Saglam R, Kabakci AS, Tokatli Z, Sarica K, Tanriverdi O, Armagan A, Tepeler A, Altintas R, Klein J, Patel A. OPTIMAL COMBINATION OF FLEXIBLE URETERO-RENOSCOPES (FUR) AND URETERAL ACCESS SHEATH (UAS) SIZE FOR SAFEST INTRA-RENAL PRESSURE (IRP) AT DIFFERENT INFLOW RATES DURING RETROGRADE INTRA-RENAL SURGERY (RIRS): PD53-06. Journal of Urology. 2018 Apr 1;199(4):e1048.

15. Fang L, Xie G, Zheng Z, Liu W, Zhu J, Huang T, Lu Y, Cheng Y. The effect of ratio of endoscope-sheath diameter on intrapelvic pressure during flexible ureteroscopic lasertripsy. Journal of Endourology. 2019 Feb 1;33(2):132-9.

16. Komeya M, Odaka H, Watanabe T, Kiuchi H, Ogawa T, Yao M, Matsuzaki J. Gap between UAS and ureteroscope predicts renal stone-free rate after flexible ureteroscopy with the fragmentation technique. World Journal of Urology. 2021 Jul;39(7):2733-9.

17. Özman O, Başataç C, Akgül M, Çakır H, Çınar Ö, Şimşekoğlu F, Yazıcı CM, Sancak EB, Baseskioglu B, Akpınar H, Önal B. The effect of ureteral access sheath use/caliber change on outcomes of retrograde intrarenal surgery, short-term kidney functions, radiation exposure, ureteroscope lifetime, and factors predicting insertion failure: a RIRSearch study. Journal of Laparoendoscopic & Advanced Surgical Techniques. 2024 Jan 1;34(1):33-8.

18. Shin D, Jeong HC, Han JY, Yang DY, Ko K, Chae HK. Clinical Impact of the Ratio of Endoscope-to-Sheath Diameter on Infectious Complications after Retrograde Intrarenal Surgery.

19. Ding T, Xu Z, Huang Z, Hu W, Xiao B, Li J. Optimizing aspiration efficiency in RIRS: the impact of ratio of endoscope-sheath diameter, irrigation flow, and negative pressure in an vitro study. Urolithiasis. 2025 May 30;53(1):102.

20. Gu H, Qin P, Shan J, Xie G, Hu J, Li Q, Huang T, Shi J, Cheng Y, Yan Z, Fang L. In-depth exploration and initial clinical practice of the ratio of endoscope-sheath diameter theory: smaller flexible ureteroscope with smaller ureteral access sheath. BMC urology. 2025 May 26;25(1):138.

Published

2026-04-13

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How to Cite

1.
Shaikh MF, Saulat S, Shaikh J, Rasheed U, Subhan Ahmed Sajjad, Mushtaque A, et al. Balancing The Ratio Between Flexible Renoscope And Different Ureteral Access Sheath Combinations and Comparing Their Effects on Post-Operative Outcome. PJMD [Internet]. 2026 Apr. 13 [cited 2026 Jun. 4];15(2):135-47. Available from: https://ojs.zu.edu.pk/pjmd/article/view/4453

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