Application of a suction sheath in transurethral nephrolithotripsy

Introduction. Urolithiasis represents a major urological challenge, affecting 10 – 15% of the population with recurrence rates of 30 – 50%. Transurethral nephrolithotripsy (TUNL) is a contemporary approach for stones ≤ 2 cm. The adoption of aspiration ureteral access sheaths enables vacuum-assisted fragment evacuation, enhancing treatment outcomes by reducing operative time and minimising infectious complications.

Objective. To evaluate the clinical efficacy and safety of aspiration sheaths during TUNL compared with standard sheaths.

Materials & methods. This prospective randomised study enrolled 32 patients with nephrolithiasis, randomised 1:1 to two groups (n = 16 each). Group 1 underwent TUNL using a 12/14 Fr aspiration sheath (ClearPetra®); group 2 received a standard 12/14 Fr ureteral access sheath (Navigator™ HD, Boston Scientific). Patient demographics, stone characteristics, and intra-/postoperative outcomes were prospectively collected and analysed.

Results. Operative and lithotripsy times were shorter in group 1. Stone-free rate (SFR) was 93.8% (group 1) versus 81.3% (group 2). Postoperative leucocytosis and C-reactive protein rises were less pronounced in group 1 (9 ± 1.3 and 5.5 ± 1.1, respectively) than group 2 (10.4 ± 2.3 and 7.9 ± 2.1). Hospital stay was shorter in group 1 (2.0 ± 0.5 days) versus group 2 (4.0 ± 0.6 days).

Conclusion. Aspiration ureteral access sheaths during TUNL offer a safe, efficacious option for renal stones ≤ 2 cm, yielding superior SFR, reduced infectious risk, and shorter hospitalisation compared with standard sheaths.

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