PDF(Pubmed)
Abstract：
The ureteral access sheath (UAS) has been a boon and a bane in flexible ureteroscopy (FURS), with its merits and demerits well established. Its design and dimensions were instrumental in reshaping the way flexible scopes were used and were key adjuncts to establishing retrograde intrarenal surgery (RIRS) as a standard of care in the endourological management of renal stones. With the ever-changing landscape of RIRS over the decades shaped by technological advancements in lasers and flexible scopes, the UAS has also continuously evolved. The utility of suction in endourology has recently changed the way RIRS is performed and is a game changer for FURS outcomes. With strong clinical and experimental evidence to support its use, the UAS has undergone a transformative change in the recent past, with its ability to monitor intrarenal pressure and provide a superior vacuum-cleaner effect that improves the trifecta of RIRS, namely an improved single-stage stone-free rate (SFR), minimise complications, and reduce reinterventions. Our comprehensive review outlines the key clinical and experimental evidence and traces the developments that were key to modifying the traditional UAS into a flexible and navigable suction ureteric access sheath (FANS) and highlights how the design and modifications, in turn, influence the ability to push the boundaries of RIRS.
摘要：
输尿管入路鞘（UAS）在输尿管软镜（FURS）中一直是恩惠和祸根，其优点和缺点已经确立。它的设计和尺寸有助于重塑柔性镜的使用方式，并且是建立逆行肾内手术（RIRS）作为肾结石腔内治疗护理标准的关键辅助手段。随着几十年来RIRS不断变化的格局由激光和灵活范围的技术进步所塑造，UAS也在不断发展。吸气在腔内的应用最近改变了RIRS的执行方式，并且是FURS结果的游戏规则改变者。有强有力的临床和实验证据支持其使用，UAS在最近的过去经历了变革性的变化，具有监测肾内压力的能力，并提供卓越的真空吸尘器效果，改善RIRS的三联功能，即改进的单级无石率(SFR)，尽量减少并发症，减少再干预。我们的全面审查概述了关键的临床和实验证据，并追溯了将传统UAS修改为灵活且可导航的吸引输尿管通道鞘（FANS）的关键发展，并强调了设计和修改，反过来,影响推动RIRS边界的能力。
