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.引言：为评估新型柔性真空辅助输尿管通路鞘（flexible vacuum-assisted ureteral access sheath, FV-UAS）在柔性输尿管镜（flexible ureteroscopy, F-URS）治疗嵌顿性非远端输尿管结石中的可行性与安全性。方法：本研究分析了2022年1月至2023年9月期间，接受FV-UAS治疗嵌顿性非远端输尿管结石的患者临床数据。评估围手术期相关参数，包括手术时长、输尿管损伤情况及并发症发生情况。该FV-UAS在输尿管通路鞘远端设有10cm被动偏转段，可随F-URS的偏转同步弯曲，同时可连接负压装置实现结石抽吸。结果：共纳入62例连续入组患者（其中女性35例）。患者平均年龄为50.0岁（范围29~75岁），最大结石平均直径为13.8mm（范围9~16mm），平均总手术时长为34.2min（范围18~46min）。57例患者（91.9%）术后未检出肾内残留结石，5例患者（8.1%）残留结石直径小于4mm。采用5级分类法量化结石嵌顿部位的输尿管损伤严重程度：0级（n=10）、1级（n=47）、2级（n=5）、3级及4级（n=0）。9例患者（14.5%）置入了双J支架（double-J stent）。2例患者（3.2%）术后出现发热，需接受抗生素治疗与保守处理。术后平均住院时长为1.2天（范围1~2天）。术后3个月随访期间，未发生输尿管狭窄，随访期内无需额外外科干预。结论：采用FV-UAS治疗嵌顿性非远端输尿管结石是一种安全有效的手术方法。