{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T05:42:51Z","timestamp":1792734171944,"version":"4.5.0"},"reference-count":17,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Endourology"],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To evaluate the safety and efficacy of a novel combined retrograde intrarenal surgery (RIRS) technique utilizing a tip-bendable suction ureteral access sheath (S-UAS) and \u00b120\u00b0 gravity-assisted (Trendelenburg\/reverse Trendelenburg) supine positioning for treating renal stones \u22653 cm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective multicenter study (3 centers) was conducted in 73 patients between October 2023 and January 2025 with renal stones \u22653 cm. A two-phase surgical approach was employed: initial lithotripsy in 20\u00b0 Trendelenburg position, followed by fragment evacuation in 20\u00b0 reverse Trendelenburg using S-UAS suction. All procedures utilized flexible ureteroscopy and a 12\/14F S-UAS. Perioperative variables\u2014including operative time, hemoglobin drop, need for second-stage procedures, 3-month stone-free rate (SFR), and complications (fever, subcapsular hematoma, and septic shock) graded by the Clavien\u2013Dindo system\u2014were recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 73 patients (mean stone size \u223c34 mm) were included. Mean operative time was 125 \u00b1 39 minutes. A second-stage RIRS was required in 32.9% of cases. The overall SFR at 3 months was Grade A (60.3%), Grade B (90.4%), and Grade C (97.3%) after one or two sessions. Postoperative fever occurred in 12.3% and subcapsular hematoma in 1.4% of patients; one patient (1.4%) developed urosepsis (septic shock, Clavien IVa) requiring intensive care unit care. No patients had long-term sequelae or required open surgery. On subgroup analysis, patients with high stone density (\u2265700 Hounsfield units) had higher second-stage RIRS rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>RIRS with a tip-bendable suction sheath combined with gravity-assisted supine positioning (\u00b120\u00b0 Trendelenburg\/Reverse Trendelenburg) for renal stones appears to be a feasible option for managing stones &gt;3 cm and may be particularly suitable for lower-density calculi. Further studies are needed to validate its effectiveness and safety in broader populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08927790251403570","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T05:50:37Z","timestamp":1764913837000},"page":"139-145","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Tip-Bendable Suction Ureteral Access Sheath Combined with Gravity-Assisted Supine Positioning (\u00b1\u200920\u00b0 Trendelenburg\/Reverse Trendelenburg) in Retrograde Intrarenal Surgery for Renal Stones \u22653 cm: A Multicenter Retrospective Evaluation of a New Technique"],"prefix":"10.1177","volume":"40","author":[{"given":"Meng-Hua","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Urology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Urology, Beijing Daxing District Hospital of Integrated Chinese and Western Medicine, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue-Lian","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Nursing, Beijing Daxing District Hospital of Integrated Chinese and Western Medicine, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12894-023-01341-3"},{"issue":"1","key":"e_1_3_6_3_2","first-page":"20","article-title":"Mini PCNL has gained more recognition in stone treatment guidelines","volume":"12","author":"Chew BH","year":"2025","unstructured":"Chew BH. Mini PCNL has gained more recognition in stone treatment guidelines. Mil Med Res, 2025; 12(1):20.","journal-title":"Mil Med Res"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1089\/end.2025.0053"},{"key":"e_1_3_6_5_2","volume-title":"EAU guidelines on urolithiasis The Netherlands","author":"Skolarikos AJH","year":"2024","unstructured":"Skolarikos AJH, , Neisius A. EAU guidelines on urolithiasis The Netherlands. European Association of Urology: Arnhem; 2024."},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2024.102724"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13092493"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.5152\/tud.2023.23142"},{"issue":"1","key":"e_1_3_6_9_2","first-page":"8","article-title":"Impact of either trendelenburg or reverse trendelenburg positioning for ureteroscopy lithotripsy procedures: A systematic review and meta-analysis","volume":"213","author":"Lepine HL","year":"2025","unstructured":"Lepine HL, , Vicentini FC, , Molina WR, et al. Impact of either trendelenburg or reverse trendelenburg positioning for ureteroscopy lithotripsy procedures: A systematic review and meta-analysis. J Urol, 2025; 213(1):8\u201319.","journal-title":"J Urol"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.3390\/jpm12122020"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-023-04654-y"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics14101034"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12894-025-01817-4"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20220229"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-93551-8"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajur.2022.02.003"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12894-025-01771-1"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12894-020-00586-6"}],"container-title":["Journal of Endourology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08927790251403570","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08927790251403570","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08927790251403570","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T20:17:46Z","timestamp":1777407466000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08927790251403570"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,19]]},"references-count":17,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2,1]]}},"alternative-id":["10.1177\/08927790251403570"],"URL":"https:\/\/doi.org\/10.1177\/08927790251403570","relation":{},"ISSN":["0892-7790","1557-900X"],"issn-type":[{"value":"0892-7790","type":"print"},{"value":"1557-900X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,19]]}}}