Retrograde intrarenal surgery (RIRS) is a minimally invasive technique for managing renal and upper ureteral stones. Ureteral access sheaths (UAS) facilitate instrument access and reduce intrarenal pressure, but their impact on stone-free rates (SFR) remains debated. Suction ureteral access sheaths (S-UAS) offer improved flexibility and can be connected to suction devices, enhancing stone fragment removal. This study aims to compare the outcomes of traditional UAS and S-UAS in RIRS.

A retrospective cohort study was conducted at Chimei Medical Center from January 2022 to December 2024, including 104 patients who underwent RIRS with either traditional UAS (n=53) or S-UAS (n=51). Baseline characteristics, operative time, stone-free rates (SFR), postoperative complications, and the need for auxiliary procedures were analyzed. Subgroup analyses assessed the impact of stone size, location, and number on outcomes.

Immediate SFR was significantly higher in the S-UAS group (82.0%) compared to the traditional UAS group (60.4%) (p=0.016). At one month, no significant difference was observed between the groups. The S-UAS group required fewer auxiliary procedures (5.9% vs. 22.6%, p=0.015) and demonstrated a higher SFR for lower calyx stones (81.8% vs. 55.2%, p=0.046). Operative time, hospital stay, and complication rates were similar between groups. The incidence of postoperative sepsis was higher in the S-UAS group, though other complications remained comparable.

The S-UAS offers significant benefits over traditional UAS in improving immediate SFR, particularly in challenging stone cases. Despite a higher rate of postoperative sepsis, S-UAS appears to be a safe and effective option for RIRS, reducing the need for auxiliary procedures and enhancing procedural efficiency. Further studies are needed to evaluate long-term outcomes and refine patient selection for optimal results.