TY  - EJOU
AU  - Hu, Ruiyang 
AU  - Chen, Nianben 
AU  - Wu, Jingxing 
AU  - Ma, Wenjun 
AU  - Cai, Youjin 
AU  - Hu, Qinglin 

TI  - Management of a large mid-ureteral stone using flexible vacuum-assisted ureteral access sheath and holmium laser lithotripsy: a case report
T2  - Canadian Journal of Urology

PY  - 
VL  - 
IS  - 
SN  - 1488-5581

AB  -  <b>Backgrounds:</b> 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. <b>Case Description:</b> 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. <b>Conclusions:</b> 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.
KW  - mid-ureteral stone; flexible ureteroscopy; vacuum-assisted access sheath; holmium:YAG laser lithotripsy; case report

DO  - 10.32604/cju.2026.078839