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The optimal ratio of endoscope-sheath diameter with negative-pressure ureteral access sheath: an in vitro research

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Abstract

Purpose

To maintain safe intrarenal pelvic pressure (IPP), the combination of flexible ureteroscope (fURS) and traditional ureteral access sheath (T-UAS) should maintain a basic rule that is the ratio of endoscope-sheath diameter (RESD) ≤ 0.75. However, the negative-pressure ureteral access sheath (NP-UAS) may break the rule of negative pressure suction. This study aimed to examine the effect of NP-UAS on IPP and flow rate (FR) with varying RESD.

Methods

In a 3D-printed renal model, flexible ureteroscopy lithotripsy (fURL) was replicated. Six sizes of fURS paired with 12Fr T-UAS and NP-UAS resulted in six distinct RESDs of 0.63, 0.78, 0.87, 0.89, 0.90, and 0.91. While the irrigation pressure (IRP) was set between 100 and 800 cmH2O and the sucking pressure (SP) was set between 0 and 800 cmH2O, the IPP and FR were measured in each RESD.

Results

NP-UASs can reduce the IPP and increase the FR at the same RESD compared to T-UASs. The IPP decreased with increasing SP with NP-UAS. When RESD ≤ 0.78, T-UAS and NP-UAS can maintain IPP < 40 cmH2O in most circumstances. When RESD = 0.87, it is challenging for T-UAS to sustain IPP < 40 cmH2O; however, NP-UAS can do so. When RESD ≥ 0.89, it is difficult to maintain an IPP < 40 cmH2O even with NP-UAS.

Conclusion

NP-UAS can decrease IPP and increase FR compared with T-UAS. To maintain a safe IPP, it is recommended that RESD < 0.85 when utilizing NP-UAS.

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Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

Ningbo Top Medical and Health Research Program (No.2022020203). The funding is not supported by any company. All author is not belonged to the company.

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Authors and Affiliations

  1. Department of Urology, The First Affiliated Hospital of Ningbo University, 59#, Liuting Street, Haishu District, Ningbo, 315000, Zhejiang, China

    Jingyu Shi, Ting Huang, Baiyang Song, Wanzhang Liu, Yue Cheng & Li Fang

  2. Health Science Center, Ningbo University, Ningbo, Zhejiang, China

    Baiyang Song

Authors
  1. Jingyu Shi
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  2. Ting Huang
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  3. Baiyang Song
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  4. Wanzhang Liu
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  5. Yue Cheng
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  6. Li Fang
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Contributions

JS: Project development, Data Collection, Data analysis, Manuscript writing. TH: Model design, Data Collection. BS: Data analysis. WL: Data Collection. YC: Data analysis. LF: Project development, Manuscript editing.

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Correspondence to Li Fang.

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Shi, J., Huang, T., Song, B. et al. The optimal ratio of endoscope-sheath diameter with negative-pressure ureteral access sheath: an in vitro research. World J Urol 42, 122 (2024). https://doi.org/10.1007/s00345-024-04815-7

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