Sheathless, Traditional, and Suction Access Sheath RIRS for Renal Stones ≤2 cm

NCT ID: NCT07289230

Last Updated: 2025-12-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

90 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-12-30

Study Completion Date

2025-08-30

Brief Summary

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This completed randomized clinical study was designed to compare three different techniques of retrograde intrarenal surgery (retrograde intrarenal surgery) for the treatment of kidney stones that are 2 centimeters or smaller. Retrograde intrarenal surgery is a minimally invasive procedure in which a flexible scope is passed through the urinary tract to reach the kidney and fragment the stone.

The clinical study included three groups of patients. The first group underwent retrograde intrarenal surgery using a traditional ureteral access sheath, which is a hollow tube placed in the ureter to facilitate the passage of instruments and help control pressure inside the kidney. The second group underwent retrograde intrarenal surgery using a suction ureteral access sheath, which combines the function of a traditional sheath with gentle suction to help remove stone fragments and reduce internal pressure. The third group underwent sheathless retrograde intrarenal surgery, in which the flexible surgical scope is inserted directly without the use of any ureteral access sheath.

The purpose of this clinical study was to determine whether these three approaches differ in terms of stone clearance, operative time, intraoperative complications such as bleeding or fluid leakage, and early postoperative complications such as fever or infection. All participants were adults with a single kidney stone between 1 and 2 centimeters, normal kidney function, and no active infection or anatomical abnormalities. All procedures were performed at Ain Shams University Hospitals using the same surgical equipment and technique to ensure comparability between groups.

Detailed Description

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Conditions

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Kidney Calculi Renal Calculi Urolithiasis Nephrolithiasis

Keywords

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Kidney stones Renal calculi Urolithiasis Endoscopic management of kidney stones Retrograde intrarenal surgery Flexible ureterorenoscopy Ureteral access sheath Suction ureteral access sheath Sheathless retrograde intrarenal surgery Minimally invasive urologic surgery

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants were randomly assigned in a parallel fashion to one of three study arms: traditional ureteral access sheath retrograde intrarenal surgery (RIRS), suction ureteral access sheath retrograde intrarenal surgery (RIRS), or sheathless retrograde intrarenal surgery (RIRS). Each participant received only one of the three techniques, and the groups were followed and compared concurrently regarding stone clearance, operative time, intraoperative complications, and early postoperative complications.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Traditional Ureteral Access Sheath Retrograde Intrarenal Surgery

Participants in this arm underwent retrograde intrarenal surgery (retrograde intrarenal surgery) using a traditional ureteral access sheath. A flexible ureteroscope was advanced through an 11 French by 13 French ureteral access sheath positioned near the ureteropelvic junction. Irrigation was maintained at 50 to 100 milliliters per minute. Stone fragmentation was performed using a holmium:yttrium-aluminum-garnet laser device. All patients received a six French double-J stent at the end of the procedure. Intraoperative complications were recorded, and postoperative imaging was performed for outcome assessment.

Group Type ACTIVE_COMPARATOR

Traditional ureteral access sheath retrograde intrarenal surgery

Intervention Type PROCEDURE

This intervention involves performing retrograde intrarenal surgery using a traditional ureteral access sheath to facilitate entry of the flexible ureteroscope and maintain controlled intrarenal pressure. The procedure includes endoscopic fragmentation of renal calculi using a holmium:yttrium-aluminum-garnet laser device and placement of a double-J ureteral stent at the end of surgery.

Suction Ureteral Access Sheath Retrograde Intrarenal Surgery

Participants in this arm underwent retrograde intrarenal surgery (retrograde intrarenal surgery) with the use of a suction ureteral access sheath. An 11 French suction ureteral access sheath was inserted over a guidewire and positioned in the renal pelvis. The suction system was connected to a vacuum device, with negative pressure set between 2 and 7 kilopascals to facilitate evacuation of stone fragments and reduce intrarenal pressure. The same flexible ureteroscope and holmium:yttrium-aluminum-garnet laser lithotripsy technique were used as in the traditional arm. A six French double-J stent was inserted at the end of the operation. All intraoperative and postoperative findings were documented.

Group Type EXPERIMENTAL

Suction ureteral access sheath retrograde intrarenal surgery

Intervention Type PROCEDURE

This intervention uses a suction ureteral access sheath that provides continuous negative pressure during retrograde intrarenal surgery. The system assists in evacuation of stone debris and helps control intrarenal pressure while the flexible ureteroscope and holmium:yttrium-aluminum-garnet laser device are used for stone fragmentation. A double-J ureteral stent is placed after the procedure.

Sheathless Retrograde Intrarenal Surgery

Participants in this arm underwent sheathless retrograde intrarenal surgery (retrograde intrarenal surgery), in which the flexible ureteroscope was inserted directly over a guidewire without the placement of any ureteral access sheath. Stone fragmentation was performed using a holmium:yttrium-aluminum-garnet laser device. A six French double-J stent was placed at the end of the procedure. Any intraoperative complications, such as bleeding or extravasation, were documented, and postoperative imaging was conducted to assess stone clearance.

Group Type EXPERIMENTAL

Sheathless retrograde intrarenal surgery

Intervention Type PROCEDURE

This intervention involves performing retrograde intrarenal surgery without the use of any ureteral access sheath. The flexible ureteroscope is introduced directly over a guidewire to access the renal collecting system for laser fragmentation of the stone using a holmium:yttrium-aluminum-garnet laser device. A double-J ureteral stent is inserted following completion of the procedure.

Interventions

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Traditional ureteral access sheath retrograde intrarenal surgery

This intervention involves performing retrograde intrarenal surgery using a traditional ureteral access sheath to facilitate entry of the flexible ureteroscope and maintain controlled intrarenal pressure. The procedure includes endoscopic fragmentation of renal calculi using a holmium:yttrium-aluminum-garnet laser device and placement of a double-J ureteral stent at the end of surgery.

Intervention Type PROCEDURE

Suction ureteral access sheath retrograde intrarenal surgery

This intervention uses a suction ureteral access sheath that provides continuous negative pressure during retrograde intrarenal surgery. The system assists in evacuation of stone debris and helps control intrarenal pressure while the flexible ureteroscope and holmium:yttrium-aluminum-garnet laser device are used for stone fragmentation. A double-J ureteral stent is placed after the procedure.

Intervention Type PROCEDURE

Sheathless retrograde intrarenal surgery

This intervention involves performing retrograde intrarenal surgery without the use of any ureteral access sheath. The flexible ureteroscope is introduced directly over a guidewire to access the renal collecting system for laser fragmentation of the stone using a holmium:yttrium-aluminum-garnet laser device. A double-J ureteral stent is inserted following completion of the procedure.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Adult patients aged 18 years or older.
* Symptomatic unilateral single renal stone with a maximal diameter from 1 centimeter to 2 centimeters.
* Normal kidney function based on routine laboratory tests.
* Patients willing and able to provide written informed consent to participate in the clinical study.

Exclusion Criteria

* Patients with active urinary tract infection (UTI) until appropriate treatment is completed and infection is cleared.
* Patients with anatomical abnormalities of the urinary tract (for example, congenital or acquired structural abnormalities).
* Pregnant patients.
* Patients who are medically unfit for general anesthesia.
* Patients with multiple renal stones in the same kidney or bilateral renal stones.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Ain Shams University

OTHER

Sponsor Role lead

Responsible Party

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AbdAlhameed Naser

Resident of Urology

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Ain Shams University Hospitals - Department of Urology

Cairo, Cairo Governorate, Egypt

Site Status

Countries

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Egypt

Other Identifiers

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FMASU_MS400_2025

Identifier Type: -

Identifier Source: org_study_id