Letter: Further Insights on the Use of Flexible Navigable Vacuum-Assisted Ureteral Access Sheath in Retrograde Intrarenal Surgery

Dear Editor,

We have read with great interest the article titled “A Comparative Study of Flexible Navigable Vacuum-Assisted Ureteral Access Sheath and Traditional Ureteral Access Sheath in Retrograde Intrarenal Surgery: Evaluating the Impact of Hydronephrosis on Stone-Free Rate and Complications” published in the Journal of Endourology. ¹ The study provides valuable insights into the efficacy and safety of flexible navigable vacuum-assisted ureteral access sheaths (FV-UAS) compared to traditional ureteral access sheaths (T-UAS) in retrograde intrarenal surgery (RIRS). However, we would like to highlight some potential areas for improvement and further research.

Firstly, while the study demonstrates that FV-UAS can achieve higher stone-free rates and reduced postoperative complications, the impact of different stone compositions on the efficacy of FV-UAS was not thoroughly explored. Previous studies have shown that stone composition can significantly influence the success of RIRS. ² Therefore, a detailed analysis of stone composition and its interaction with FV-UAS could provide more comprehensive insights into the optimal use of this technology.

Secondly, the study did not provide detailed information on the long-term outcomes of patients treated with FV-UAS. Long-term follow-up data are crucial to assess the durability of stone clearance and the incidence of late complications such as recurrent stone formation or renal function impairment. Future studies should consider incorporating longer follow-up periods to better understand the long-term benefits and risks associated with FV-UAS.

Thirdly, the study did not compare FV-UAS with other advanced technologies such as the novel tip-flexible suctioning ureteral access sheath (NTFS-UAS) or the ClearPETRA aspiration-assisted ureteral access sheath. These technologies have shown promising results in reducing operative time and improving stone-free rates. ³ A comparative analysis with these newer sheaths could provide a more complete picture of the current landscape of ureteral access sheaths in RIRS. ⁴

Lastly, the study did not address the potential economic implications of using FV-UAS. Given the increasing focus on cost-effectiveness in health care, it would be beneficial to evaluate the economic impact of FV-UAS compared to T-UAS, including factors such as device cost, procedural time, and overall health care resource utilization. ⁵

In conclusion, while the study by Arikan et al. provides important findings on the use of FV-UAS in RIRS, further research is needed to address the limitations mentioned above. We believe that such studies will contribute significantly to the optimization of RIRS procedures and improve patient outcomes.