Objective:To analyze the application and efficacy of ureteral access sheath(UAS)core dilatation in the one-stage flexible ureteroscopy(fURS)for patients with difficult placement of the UAS due to narrow ureter.Methods:From May 2021 to May 2023,a total of 23 patients who underwent one-stage fURS without preoperative ureteral stenting were included in this study.These patients had upper ureteral or renal stones and encountered difficulties in UAS placement due to the overall narrow ureter.They underwent UAS core dilatation combined with fURS.All patients had narrow ureters with smooth mucosa,without obvious stenosis or mechanical/func-tional obstructions,leading to difficulties in UAS placement.Among the patients,there were 13 males and 10 fe-males,aged between 26 and 63 years with a mean age of(42.61±12.65)years.The stone size ranged from 0.6 to 1.8 cm with a mean size of(1.07±0.36)cm.The success rate of one-stage UAS placement,stone-free rate(SFR)at the first day after surgery and at 3 months postoperatively,changes in renal hydronephrosis at 3 months post-operatively,and complications such as iatrogenic ureteral stenosis were statistically analyzed.Results:All 23 sur-geries were successfully completed.The success rate of one-stage UAS placement was 78.3％(18/23),and the one-stage SFR was 87.0％(20/23).The SFR at the first day and at 3 months postoperatively were both 100％.No renal hydronephrosis,ureteral perforation,sepsis,or strictures were observed at 3 months postoperatively.The postoperative hospital stay ranged from 1 to 3 days with an average of(1.91±0.51)days.For 2 cases with ureteral stones ≤1 cm,after failed UAS core dilatation and UAS placement attempts,successful lithotripsy was achieved using fURS without the use of UAS.For 2 cases with renal stones＞1 cm,after failed UAS core dilata-tion and UAS placement attempts,a ureteral stent was placed instead,and successful UAS placement and stone clearance were achieved in the second-stage procedure after 2 weeks.In one case,after successful UAS core dilata-tion,the UAS placement process was difficult,and subsequently,ureteroscopy revealed a 0.5 cm long grade 1 u-reteral injury in the upper ureter.After the placement of a ureteral stent for 4 weeks,successful second-stage fURS was performed to achieve stone clearance.Postoperative complications such as hematuria and lumbosacral discomfort occurred in some patients,but they were managed symptomatically or resolved after removal of the u-reteral stent.Conclusion:UAS core dilatation is safe and effective in the one-stage fURS for patients with difficult UAS placement due to benign narrow ureters without preoperative ureteral stenting.It improves the success rate of one-stage UAS placement and SFR,without additional hospitalization expenses or time,and without increasing the duration of ureteral stent placement or related complications.
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