Utilization of Flexible Ureteroscopy in Conjunction with Flexible Vacuum-Assisted Ureteral Access Sheath for the Management of 1-2cm Complex Lower Calyceal Calculi
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Purpose To assess the efficacy and safety of flexible ureteroscopy (FURL) in conjunction with flexible vacuum-assisted ureteral access sheath (FV-UAS) for the treatment of 1–2 cm complex lower calyceal stones, in comparison to conventional FURL. Methods A retrospective analysis was performed on 69 patients with 1–2 cm complex lower calyceal stones treated from July 2023 to February 2025. Patients were categorized into an observation group (n = 36) administered FURL with FV-UAS and a control group (n = 33) administered standard FURL with a conventional ureteral access sheath. All surgeries were conducted by the same proficient surgeon. Preoperative characteristics, stone clearance rates, surgical duration, length of hospital stay, and postoperative complications were compared across groups. Results No notable variations were detected in baseline variables such as age, gender, BMI, stone diameter, and stone density between the two groups (P > 0.05). The stone clearance rate in the observation group was markedly superior to that of the control group (77.8% vs. 51.5%, P = 0.022). The observation group exhibited reduced surgical durations (63.25 ± 8.32 min vs. 74.33 ± 15.61 min, P < 0.001), diminished hospital stays (3.17 ± 0.46 d vs. 5.06 ± 1.42 d, P < 0.001), and decreased incidences of postoperative fever (0% vs. 12.1%, P = 0.031). Conclusions The combination of FURL and a flexible vacuum-assisted ureteral access sheath exhibited enhanced efficacy and safety in the management of 1-2cm complicated lower calyceal stones relative to conventional FURL. This method led to enhanced stone clearance rates, decreased operational durations, shortened hospitalizations, and less postoperative problems, offering a promising new alternative for addressing this difficult stone presentation. Expanded sample sizes and multicenter investigations are necessary to substantiate these results.
