Novel Syphon Ureteric Access Sheath Has the Potential to Improve Renal Pressures and Irrigant Flow

OBJECTIVE To describe a novel syphon ureteral access sheath (UAS) intended for use during flexible uretero-renoscopy (fURS). We aimed to report on a pilot study as well as intrarenal pressures (IRP) and irrigant flow volumes compared to traditional UAS.METHODS Patients undergoing routine fURS for single, <2cm intrarenal nephrolithiasis were identified, and written informed consent was obtained. Irrigation via the fURS was instilled through the novel 11/13 Fr UAS without (a proxy for a traditional UAS) and with the novel syphon box attached. Measured minute irrigant flow volume, steady state and bolus IRP were compared.RESULTS Ten participants (6 males and 4 females) were treated with the syphon UAS. All procedures were completed safely without intraoperative complications. The mean baseline IRP with and without the syphon was 18 vs 29 mmHG (P < .001, SD 4.0 vs 4.8). The mean minute irrigant flow volume with and without the syphon was 31 vs 21 ml (P < .001, SD 6.4 vs 3.3). The mean peak IRP following a 10 ml bolus with and without the syphon was 71 vs 104 mmHg (P = .03, SD 74 vs 59).CONCLUSION The described novel UAS is different from traditional devices by incorporating a syphon mecha-nism. This pilot trial demonstrates that the novel syphon UAS may hold clinical potential to reduce IRP and increase irrigant flow compared to traditional UAS. Firm conclusions about effi-cacy and safety require assessment of the device in a larger clinical trial. UROLOGY 176: 50 -54, 2023. & COPY; 2023 Elsevier Inc.