Optimal deflection techniques for flexible and navigable suction ureteral access sheaths (FANS): a comparative in vitro PEARLS analysis.
Deflection angle
Flexible and navigable suction ureteral access sheaths
Flexible ureteroscopy
Sheath advancement
Suction
Ureteroscope deflection
Journal
World journal of urology
ISSN: 1433-8726
Titre abrégé: World J Urol
Pays: Germany
ID NLM: 8307716
Informations de publication
Date de publication:
30 Oct 2024
30 Oct 2024
Historique:
received:
12
06
2024
accepted:
26
09
2024
medline:
31
10
2024
pubmed:
30
10
2024
entrez:
30
10
2024
Statut:
epublish
Résumé
Flexible and navigable suction ureteral access sheaths (FANS) have been introduced without current evidence on how to optimize deflection. Aim was to evaluate in vitro deflection angles with 2 different FANS techniques-sheath advancement and ureteroscope deflection; and effects of sheath size-ureteroscope combinations. We evaluated in vitro deflection angles of 10/12Fr, 11/13Fr and 12/14Fr FANS (Hunan Reborn Medical Co. Ltd) with six single-use flexible ureteroscopes (Pusen Uscope 7.5Fr, OTU WiScope 7.5Fr, OTU WiScope 8.6Fr, Innovex EU-scope 8.7Fr, Red Pine RP-U-C12 8.7Fr and Boston Scientific Lithovue 9.5Fr). Two deflection techniques were tested: (1) sheath advancement-advancing the sheath forward over a maximally deflected ureteroscope, and (2) ureteroscope deflection-maximally deflecting the ureteroscope from various starting positions relative to tip of the sheath. Intra and inter-scope comparisons of maximum deflection angles were significantly different (all ANOVA p < 0.01). Largest maximum angles for all ureteroscopes were with the sheath advancement technique (range 218°-277°), and second largest for most scopes using the ureteroscope deflection technique at tip (range 111°-212°), mostly deviating from manufacturer specifications (range 270°-275°). 10/12Fr and 11/13Fr sheath sizes were more flexible than 12/14Fr. Largest angles were with 11/13Fr sheath-OTU8.6Fr/Innovex8.7Fr combinations. Optimal deflection with FANS is achieved using either a sheath advancement technique, or ureteroscope deflection technique at tip. Despite using these optimized techniques, deflection angles specified by manufacturers seem hardly achievable. The sheath advancement technique and 11/13Fr sheath-OTU8.6Fr/Innovex8.7Fr combinations may be better suited for lower pole situations. Urologists should be aware of these differences and apply the findings to their FANS technique.
Identifiants
pubmed: 39476254
doi: 10.1007/s00345-024-05297-3
pii: 10.1007/s00345-024-05297-3
doi:
Types de publication
Journal Article
Comparative Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
606Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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