Journal of Nepal Medical Association · Published 2026-07-29 · DOI 10.31729/jnma.v64i300.9612
Rishav Sharma, Parash Mani Shrestha, Robin Bahadur Basent, Arvind Kumar Shah, Baikuntha Adhikari, Udita Mishra, Akash Chitrakar, Jainendra Kumar Manoj, Anil Shrestha
Introduction: To evaluate the stone-free rate and complications following retrograde intrarenal surgery using the flexible and navigable suction ureteral access sheath for nephrolithiasis. Methods: A prospective observational study was conducted at Bir Hospital, Kathmandu, Nepal, between April 2025 and January 2026. Patients aged over 16 years with nephrolithiasis undergoing retrograde intrarenal surgery with flexible and navigable suction ureteral access sheaths were enrolled. Laser lithotripsy was carried out with Thulium Fiber Laser or Holmium: Yttrium-Aluminum-Garnet laser Stone free rate was assessed at 4 weeks using X-ray and ultrasonography of the kidneys, ureters, and bladder. Complications were graded by the ClavienDindo and ureteric injury was graded using Traxer ureteric injury classification systems. Results: Sheath negotiation to the kidney was achieved in 151 (74.75%) with access to all calyces in 193 (95.54%) of cases. Median operative duration was 43.6 minutes. Stone volume of less than 1000mm3 found to have better stone free rate than volume less than 1000 mm3. Post-operative fever occurred in 8 (6.34%) of cases. Major grades (Grade III and above) of ureteric injury were not seen. Conclusions: Use of flexible and navigable suction ureteral access sheaths resulted in high stone-free rates and low infectious complication rates. Stone volume was associated with better stone-free rates, whereas stone location and operative duration showed similar stone-free rates.
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Sharma, R., Shrestha, P., Basent, R., et al. (2026). Safety and Efficacy of Flexible and Navigable Suction Ureteral Access Sheath in Retrograde Intrarenal Surgery: A Prospective Study. Journal of Nepal Medical Association. https://doi.org/10.31729/jnma.v64i300.9612