• Xiaoyuan Qian, Chenqian Liu, Senyuan Hong, Jinzhou Xu, Can Qian, Jianning Zhu, Shaogang Wang, and Jiaqiao Zhang.
• Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
• Int. J. Clin. Pract. 2022 Jan 1; 2022: 93547149354714.

PurposeTo clarify the efficiency and outcomes of suctioning ureteral access sheath (UAS) during flexible ureteroscopic lithotripsy (fURL) for the management of renal stones.MethodsBetween January 2017 and January 2019, a total of 444 patients with renal stones undergoing fURL were divided into suctioning UAS and nonsuctioning UAS groups. The outcomes of patients in both groups were compared using a matched-pair analysis (1 : 1 scenario). Furthermore, a directed acyclic graph (DAG) was drawn to guide the multivariate logistic regression model and analyze the protective effect of suctioning UAS on the incidence of postoperative systemic inflammatory response syndrome (SIRS).ResultsBefore propensity score matching, significant differences were observed between the two groups in blood white cell counts, urine white cell counts, preoperative fever, preoperative indwelling stents, and laterality (P < 0.05). Eighty-one patients in the suctioning UAS group were successfully matched with 81 patients in the nonsuctioning group. The stone-free rate (SFR) on postoperative day 1 after fURL in the suctioning group was higher than that in the nonsuctioning group (86.4% vs. 71.6%; P=0.034), whereas it was comparable between the two groups 1 month after the surgery (88.9% vs. 82.7%; P=0.368). The incidence of postoperative fever or SIRS was lower in the suctioning group (fever: 3.70% vs. 14.8%; P=0.030; SIRS: 1.23% vs. 12.3%; P=0.012). However, the operative duration was similar in both groups (mean (SD)) (72.9 (28.1) min vs. 80.0 (29.5) min; P=0.121). The result of the multivariate logistic regression model guided by DAG revealed that the application of nonsuctioning UAS (odds ratio: 5.28 [1.38-35.07], P=0.034) during fURL was associated with postoperative SIRS.ConclusionsThe application of suctioning UAS during fURL was associated with higher SFR on day 1 after surgery and a lower incidence of postoperative fever or SIRS.Copyright © 2022 Xiaoyuan Qian et al.

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