The Innovex RS Delivery Catheter as a Single-Platform Endoscopic System for Upper Urinary Tract Intervention: A Two-Case Report of Upper Ureteral Lithotripsy and Ablation of a Suspected Renal Pelvis Urothelial Lesion.

Abstract

Background: Conventional upper urinary tract endoscopy requires two instruments-a rigid ureteroscope for initial access and a flexible ureteroscope for intraluminal treatment-resulting in intraoperative scope exchange and dual-tower dependency. The Innovex RS delivery catheter is a rigid stainless-steel sheath that enables a single-use 7.5 Fr flexible ureteroscope to function in both rigid and flexible operative modes from one platform. To our knowledge this is the first report of a rigid-delivery sheath system used as the sole endoscopic instrument across two distinct upper urinary tract indications, and the first describing its use for ablation of a renal pelvis lesion.

Cases: Two patients underwent upper urinary tract endoscopy using the RS catheter as the sole instrument: a 53-year-old male with a 12 mm impacted proximal ureteral stone (holmium:YAG lithotripsy), and a 76-year-old female with a 10 mm renal pelvis filling defect, radiologically suspected to represent urothelial pathology on the basis of CT attenuation, who underwent cold-cup biopsy followed by thulium:YAG ablation. No rigid ureteroscope, tower switching, or fluoroscopic guidance was used in either case; this reflected operator judgement rather than any intrinsic capability of the device.

Results: Stone-free status was confirmed by non-contrast computed tomography on postoperative day 1 in Case 1. Macroscopic complete ablation was achieved in Case 2. Histopathological examination of the biopsy specimen demonstrated inflammatory exudate with focal urothelial mucosa and mild epithelial atypia, without definitive invasive malignancy. The ablated lesion therefore remains a radiologically suspected but histopathologically unconfirmed urothelial neoplasm, and the patient has entered a structured surveillance programme. Operative times were 55 and 90 minutes respectively; in Case 2, approximately 60 of the 90 minutes were attributable to intrapelvic clot evacuation. Clavien-Dindo grades were 0 and I respectively.

Conclusion: The RS delivery catheter system enabled single-platform, single-tower ureteroscopy without scope exchange in two patients. These proof-of-concept observations establish technical feasibility only. They are not sufficient to demonstrate superiority, equivalent efficacy, improved safety, or cost-effectiveness relative to the conventional two-instrument workflow, and any such advantages remain hypotheses requiring prospective comparative evaluation.