Management of a large mid-ureteral stone using flexible vacuum-assisted ureteral access sheath and holmium laser lithotripsy: a case report

Ruiyang Hu¹, Nianben Chen², Jingxing Wu², Wenjun Ma³, Youjin Cai³, Qinglin Hu^3,*
1 The Second Clinical Medical College of Anhui Medical University, Hefei, China
2 The First Clinical Medical College of Anhui University of Chinese Medicine, Hefei, China
3 Department of Urology, Chuzhou Integrated Hospital of Chinese and Western Medicine, Affiliated to Anhui University of Traditional Chinese Medicine, Chuzhou, China
* Corresponding Author: Qinglin Hu. Email: email

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.078839

Received 09 January 2026; Accepted 09 June 2026; Published online 24 July 2026

Abstract

Backgrounds: Management of large mid-ureteral stones remains challenging due to anatomical constraints and the limitations of traditional techniques. Recent advances in flexible ureteroscopy and vacuum-assisted access sheaths offer new strategies for safe and effective stone removal. Case Description: We report the case of a 60-year-old male who presented with right-sided colicky flank pain. Non-contrast computed tomography revealed a 62 × 14 mm high-density stone located in the right mid-ureter, with associated hydronephrosis. Laboratory tests were largely unremarkable. The patient underwent successful holmium:YAG laser lithotripsy using a disposable digital flexible ureteroscope inserted through a deflectable vacuum-assisted ureteral access sheath. Continuous low-pressure suction minimized stone migration and maintained a clear surgical field. The procedure was completed in a single session without complications. Postoperative KUB radiography at one month confirmed complete stone clearance and normal urinary drainage. Conclusions: This case illustrates the short-term feasibility and clinical benefit of vacuum-assisted flexible ureteroscopy for treating large mid-ureteral stones. It may serve as a minimally invasive, efficient, and safe alternative to traditional surgical approaches, broad claims regarding its generalized safety require further validation with objective intraoperative measurements in larger cohorts.