Temperature activated deflection of a novel ureteroscopic laser fiber sheath

Purpose: Loss of active deflection with insertion of a holmium laser fiber can significantly decrease the efficacy of intrarenal flexible ureteroscopy. We evaluated the impact of inserting a novel, temperature activated, deflectable laser sheath on active deflection and flow rates. Methods and Materials: Active deflection of 5 flexible ureteroscopes was measured with an empty channel and following separate insertions of 2, 272 μm holmium fibers. Insertion of the same fibers was then repeated through a proprietary, temperature activated, coiling nitinol sheath. Active deflection of the sheath following insertion into the working channel was achieved by a rapid flush of 10 cc hot water (60C) through the irrigation side port. Release of active deflection was obtained by repeating this maneuver with cold water (15C). Degrees of deflection were measured in triplicate. Flow rates were measured at 100 cm H₂O pressure. Results: Active deflection with an empty working channel decreased significantly with insertion of the 2 laser fibers (12 to 32 degrees). Insertion of the laser fiber through the nitinol sheath followed by temperature activation of the sheath maximized active deflection beyond baseline measures with the laser fibers by up to 60 degrees. Flow rates in all ureteroscopes decreased significantly with the use of the Powerflex sheath (Optical Integrity, Panama City, Florida) but it remained above 12 ml per minute in all ureteroscopes. Conclusions: A temperature activated, deflectable nitinol sheath facilitates active deflection with a 272 μm holmium laser fiber in the working channel of the flexible ureteroscope, suggesting strong potential for clinical evaluation.