Clinical Research Directory

Flexible Ureteroscopy With Novel Flexible Ureteral Access Sheath Versus Mini-Percutaneous Nephrolithotomy for Treatment of 2-3cm Lower Calyceal Renal Stones

The aim of the study is to compare the efficacy, safety, and patient outcomes of flexible ureteroscopy with a novel flexible ureteral access sheath and mini-percutaneous nephrolithotomy in the treatment of 2-3 cm lower calyceal renal stones.

Ureteral Access Strategies in Retrograde Intrarenal Surgery

Retrograde intrarenal surgery (RIRS) is a standard minimally invasive treatment for kidney stones up to 20 mm. During the procedure, irrigation fluid raises the pressure inside the kidney and laser energy raises the fluid temperature. High intrarenal pressure has been linked to postoperative pain, fever and infection. Ureteral access sheaths are used to improve fluid outflow, and newer flexible and navigable suction access sheaths (FANS) add active aspiration to keep pressure low and remove stone fragments. This randomized controlled trial compares three ureteral access strategies in adults undergoing RIRS: a flexible and navigable suction access sheath, a conventional ureteral access sheath, and no access sheath. The main question is whether the access strategy affects pain 6 hours after surgery. The study also compares intrarenal pressure and temperature during surgery, the amount of irrigation fluid used and retained, stone-free status on computed tomography (CT), and complications.

The Efficacy and Safety of Adjunctive Alpha-blocker Therapy Before Flexible Ureteroscopy in the Management of Upper Ureteric Stones in Pediatrics Group

A unique aspect of pediatric URS is the smaller ureteral diameter, which often results in failure to access the ureter during an initial URS attempt. Ureteral orifice navigation is often limited at the level of the ureteral orifice or intramural ureter. α1 adrenergic receptors are densely located at this level, and α-antagonists can reduce the tension of the intramural segment The purpose of this study was to evaluate if preoperative treatment with tamsulosin is associated with an increased rate of successful first-time ureteral orifice navigation in a school-age pediatric population, defined as patients 5-18 years old.

Criteria for DJ Stent Omission Following Retrograde Intrarenal Surgery Using Flexible and Navigable Suction Sheath: A Prospective Cohort Study

Retrograde intrarenal surgery is widely used for the treatment of upper urinary tract stones. Traditionally, ureteral stents are placed postoperatively to prevent complications such as pain and stone obstruction. On the other hand, it leads to patient discomfort and additional procedures or readmission .This study aims to evaluate whether routine postoperative DJ stenting can be safely omitted following RIRS in appropriately selected patients, without increasing postoperative complications or the need for additional interventions.

Flexible vs Semi-rigid URS

To compare the efficacy, safety, success rate, operative time, and cost-effectiveness of flexible ureteroscopy versus semirigid ureteroscopy in the management of upper ureteric stones smaller than 2 cm. The investigators' main concern in this study is Upper third ureteric stones to determine which cases can be treated with Semi-Rigid Ureteroscopy, and which one needs flexible ureteroscopy. This depends on several factors: 1. Division of the upper third of the ureter 2. Stone size 3. Stone impaction 4. Surgeon experience 5. Anesthesia 6. Ureteric dilatation above the stone 7. Mini endoscopy

Bendable Suction Ureteral Access Sheath Versus Conventional Ureteral Access Sheath in Management of Renal Stones Using Flexible Ureteroscopy

Urinary calculus is a globally recognized urological condition, with prevalence rates ranging from 1% to 13% across different geographical regions (1) Therapeutic approaches for renal calculi encompass extracorporeal shock wave lithotripsy (ESWL) and minimally invasive endoscopic surgical techniques, such as percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Treatment plans depend on the characteristics of calculi, patient factors, surgeon experience and the condition of medical centers. According to the guidelines of American Urologic Association (AUA) and European Association of Urology (EAU), patients with a burden of less than 20 mm in kidney calculi can choose RIRS as the frst-line surgical treatment with good stone-free rate (SFR). (2, 3) The application of RIRS for urinary stones has increased signifcantly, and the indications have expanded due to developments in minimally invasive technology and equipment. (4) With the development of stone retrieval devices and miniaturized fexible ureteroscopes, RIRS is more widely used for treating renal calculi, even for high burden stones. (5, 6) The application of ureteral access sheath (UAS) in RIRS can improve surgical vision, reduce intrarenal pressure (IRP), and decrease postoperative infectious complications. (7-9) Several reports have demonstrated the superiority of suctioning UAS, including shorter operation time, higher SFR and lower incidence of infectious complications compared with traditional ureteral access sheath, but none of these suctioning UAS can reach the renal calyces. (10-12) A novel tip-flexible suctioning ureteral access sheath with flexible terminal was designed, which delivered the tip of the ureteral access sheath to renal calyces. However, data comparing novel tip-flexible suctioning ureteral access and traditional ureteral access sheath is lacking in RIRS. Therefore, we designed a prospective controlled analysis to compare the efficacy and safety of novel tip-flexible suctioning ureteral access sheath and traditional ureteral access sheath combined with flexible ureteroscope (FURS) in treating renal calculi.