Benefits of Ureteral Access Sheath in Retrograde Flexible Ureteroscopic Lithotripsy

逆行肾内输尿管软镜碎石术(Retrograde Intrarenal Surgery, RIRS)是一种通过输尿管软镜实施的微创碎石技术，现已成为各类肾结石的一线或二线治疗方案，包括>20 mm的结石。随着输尿管通路鞘(Ureteral Access Sheath, UAS)的持续改进，其在RIRS中的应用价值日益凸显。UAS可通过辅助重复进入上尿路、降低肾内压力、保护输尿管镜、提升结石清除率等机制显著优化手术效果。尽管UAS的置入可能伴随输尿管损伤等风险，但其临床收益仍备受泌尿外科医生及患者认可。本文系统综述UAS在RIRS中的应用优势及潜在风险，以期为临床实践提供参考。Retrograde Intrarenal Surgery (RIRS) is a minimally invasive lithotripsy technique performed via a flexible ureteroscope, which has become a first- or second-line treatment for various kidney stones, including those > 20 mm in size. With continuous improvements in the Ureteral Access Sheath (UAS), its application value in RIRS has become increasingly prominent. UAS optimizes surgical outcomes through mechanisms such as facilitating repeated access to the upper urinary tract, reducing intrarenal pressure, protecting the ureteroscope, and enhancing stone clearance rates. Although UAS insertion may carry risks like ureteral injury, its clinical benefits are widely recognized by urologists and patients. This article systematically reviews the advantages and potential risks of UAS in RIRS to provide a reference for clinical practice.