Introduction: The aim of this study was to evaluate the feasibility and safety of using the novel flexible vacuum-assisted ureteral access sheath (FV-UAS) in flexible ureteroscope (F-URS) treatment of impacted non-distal ureteral stones. Methods: We analyzed data from patients who underwent FV-UAS treatment for impacted non-distal ureteral stones between January 2022 and September 2023. Perioperative parameters were evaluated, including operative time, ureteral injury, and complications. The FV-UAS have a 10-cm passive deflection segment at the distal end of the ureteral access sheath that can bend following the deflection of the F-URS, while also being connected to a vacuum device for aspiration. Results: A total of 62 consecutive patients (35 females) were included. Mean (range) patient age was 50.0 (29–75) years. Mean (range) largest stone size was 13.8 (9–16) mm. Mean (range) total time was 34.2 (18–46) min. In 57 patients (91.9%), no residual stones were detected in the renal, while 5 patients (8.1%) had residual stones smaller than 4 mm. A 5-tier classification quantified ureteral injury severity at stone impaction sites: grade 0 (n = 10); grade 1 (n = 47); grade 2 (n = 5); and grades 3 and 4 (n = 0). Nine patients (14.5%) underwent the placement of two double-J stents. Two patients (3.2%) developed postoperative fever requiring antibiotics and conservative management. Mean (range) postoperative hospital stay was 1.2 (1–2) day. At the 3-month follow-up, no ureteral strictures had occurred. No additional surgical interventions were necessary during the follow-up. Conclusion: The use of the FV-UAS for the treatment of impacted non-distal ureteral stones is a safe and effective surgical method.

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