Application of Suctioning Ureteral Access Sheath during Flexible Ureteroscopy for Renal Stones Decreases the Risk of Postoperative Systemic Inflammatory Response Syndrome

Abstract

Purpose. To clarify the efficiency and outcomes of suctioning ureteral access sheath (UAS) during flexible ureteroscopic lithotripsy (fURL) for the management of renal stones. Methods. Between January 2017 and January 2019, a total of 444 patients with renal stones undergoing fURL were divided into suctioning UAS and nonsuctioning UAS groups. The outcomes of patients in both groups were compared using a matched-pair analysis (1 : 1 scenario). Furthermore, a directed acyclic graph (DAG) was drawn to guide the multivariate logistic regression model and analyze the protective effect of suctioning UAS on the incidence of postoperative systemic inflammatory response syndrome (SIRS). Results. Before propensity score matching, significant differences were observed between the two groups in blood white cell counts, urine white cell counts, preoperative fever, preoperative indwelling stents, and laterality ( P < 0.05 ). Eighty-one patients in the suctioning UAS group were successfully matched with 81 patients in the nonsuctioning group. The stone-free rate (SFR) on postoperative day 1 after fURL in the suctioning group was higher than that in the nonsuctioning group (86.4% vs. 71.6%; P = 0.034 ), whereas it was comparable between the two groups 1 month after the surgery (88.9% vs. 82.7%; P = 0.368 ). The incidence of postoperative fever or SIRS was lower in the suctioning group (fever: 3.70% vs. 14.8%; P = 0.030 ; SIRS: 1.23% vs. 12.3%; P = 0.012 ). However, the operative duration was similar in both groups (mean (SD)) (72.9 (28.1) min vs. 80.0 (29.5) min; P = 0.121 ). The result of the multivariate logistic regression model guided by DAG revealed that the application of nonsuctioning UAS (odds ratio: 5.28 [1.38–35.07], P = 0.034 ) during fURL was associated with postoperative SIRS. Conclusions. The application of suctioning UAS during fURL was associated with higher SFR on day 1 after surgery and a lower incidence of postoperative fever or SIRS.

Scoping Review of Experimental and Clinical Evidence and Its Influence on Development of the Suction Ureteral Access Sheath

“…Zhu's comparative study showed that patients undergoing FURS with SUAS had a mean operative time of 49.7 ± 16.3 min, which was significantly shorter than the 57.0 ± 14.0 min observed in the traditional UAS group (p < 0.001), indicating the efficiency of SUAS in reducing operative time [41]. However, Qian et al found no significant difference in operative times between SUAS and traditional UAS groups, with means of 72.9 min and 80.0 min, respectively (p = 0.121), demonstrating that the impact of SUAS on operative time may vary depending on other unreported factors [42]. Considering the variability in operative times across studies, the use of SUAS has been enhanced by integrating an intelligent pressure-control system (IPCS).…”

“…Huang's prospective study found a slight reduction in operative time, although statistically insignificant (p = 0.235), in time with FANS compared to traditional UAS, averaging 37.7 versus 40.3 min, respectively [49]. Qian et al [42] fever: 3.70% vs. 14.8%; p = 0.030; SIRS: 1.23% vs. 12.3%;…”

A nomogram for predicting postoperative urosepsis following retrograde intrarenal surgery in upper urinary calculi patients with negative preoperative urine culture

“…Notably, these effects were most pronounced when large-diameter UAS was used 28 . Recent studies have shown that suctioning UAS 29 and the novel flexible vacuum-assisted UAS 30 are better at maintaining low intrapelvic pressure and reducing the incidence of postoperative infectious complications.…”

“…Notably, these effects were most pronounced when large-diameter UAS was used 28 . Recent studies have shown that suctioning UAS 29 and the novel flexible vacuum-assisted UAS 30 are better at maintaining low intrapelvic pressure and reducing the incidence of postoperative infectious complications. Previous studies have reported some independent risk factors related to postoperative infection complications of RIRS, such as the presence of urine nitrite 9 , positive UC 8,9 , large stone burden, and diabetes mellitus 31,32 .…”

Directed acyclic graphs in perioperative observational research–A systematic review and critique against best practice recommendations

“…After this round of full text screening, nineteen studies were included in the final review. Five of these nineteen studies [16,17,[19][20][21] were identified during the updated search in June 2022. References of the final nineteen studies were also screened for relevant studies.…”