Supplementary Material for: Flexible Vacuum-assisted Ureteral Access Sheath for Treating Impacted Ureteral Stones

Introduction: To evaluate the feasibility and safety of using the novel flexible vacuum-assisted ureteral access sheath (FV-UAS) in flexible ureteroscopy (F-URS) treatment of impacted non-distal ureteral stones.
Methods: We analyzed data from patients who underwent FV-UAS treatment for impacted non-distal ureteral stones between January 2022 and September 2023. Perioperative parameters were evaluated, including operative time, ureteral injury, and complications. The FV-UAS have a 10 cm passive deflection segment at the distal end of the ureteral access sheath that can bend following the deflection of the F-URS, while also being connected to a vacuum device for aspiration.
Results: A total of 62 consecutive patients (35 females) were included. Mean (range) patient age was 50.0 (29-75) years. Mean (range) largest stone size was 13.8 (9-16) mm. Mean (range) total time was 34.2 (18-46) min. In 57 patients (91.9%), no residual stones were detected in the renal, while 5 patients (8.1%) had residual stones smaller than 4 mm. A 5-tier classification quantified ureteral injury severity at stone impaction sites: grade 0 (n=10); grade 1 (n=47); grade 2 (n=5); grade 3 and 4 (n=0). Nine patients (14.5%) underwent placement of two double-J stent. Two patients (3.2%) developed postoperative fever requiring antibiotics and conservative management. Mean (range) postoperative hospital stay was 1.2 (1-2) day. At the 3-month follow-up, no ureteral strictures had occurred. No additional surgical interventions were necessary during follow-up.
Conclusion: The use of the FV-UAS for the treatment of impacted non-distal ureteral stones is a safe and effective surgical method.