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JNW UrTrac Sheath

The JNW UrTrac® (LSI Solutions, Victor, NY) is a 26 Fr dual-lumen transurethral cannula used in transurethral incision with transverse mucosal realignment (TUITMR) for vesicourethral anastomotic stenosis and bladder-neck contracture. Separate ports accommodate a 3 mm scope and 5 mm instrument; the device provides access and irrigation, while companion instruments place and secure sutures.[1][2][3]

Design​

  • Dual obturator for initial cannula placement, optionally over a guidewire through the obturator's guidewire channel. The IFU advises standard dilation technique and lubrication to ease insertion.[2]
  • Rotational seal and scope lock accommodate a 3 mm scope and 5 mm device separately; rotating the seal closed reduces fluid loss through the 5 mm port but blocks passage of an instrument through the lower lumen, so open it before passing the instrument.[2] There is no pneumoperitoneum in this transurethral procedure.
  • Irrigation and drainage connectors and a separate instrument port permit visualization alongside the RD180 suturing device and Ti-Knot fastener.[2]

Use in Endoscopic Urethroplasty​

In the TUITMR technique:

  1. Introduce the cannula with the dual obturator, with a guidewire if indicated; remove the obturator and guidewire after positioning.[2]
  2. Seat the scope lock and rotational seal; introduce the appropriately sized scope through its dedicated port and connect irrigation or drainage.
  3. After scar incision, use the separate instrument port for RD180 to advance and appose healthy mucosa across the incised stenosis; ideally the needle enters bladder mucosa proximal to the resection bed, and the distal bite takes as little of the resection bed as possible, giving mucosa-to-mucosa apposition.[1]
  4. Secure sutures with Ti-Knot fasteners as described in the technique report.

The manufacturer specifies sterile single-patient use, without reuse or resterilization. Do not force a scope or instrument through a resistant port, avoid contact between the noninsulated cannula and electrosurgical equipment, and observe the IFU's irrigation-fluid absorption and electrosurgery-medium precautions.[2]

Clinical Context — TUITMR​

Transurethral Incision with Transverse Mucosal Realignment (TUITMR) incises scar and apposes healthy mucosa across the stenotic segment. Abramowitz et al.'s retrospective series of 19 patients with bladder-neck contracture or vesicourethral anastomotic stenosis used a 26 Fr continuous-flow cystourethroscope sheath, then an offset scope, rather than the later JNW UrTrac platform. At median six-month follow-up, 17/19 (89%) had cystoscopic patency after one treatment and 19/19 after up to two; patency meant passage of a 17 Fr flexible cystoscope at four months.[4] No de novo incontinence was observed.[4] In a later registry series of 92 men with bladder-neck contracture after BPH surgery (median follow-up 15.9 months), freedom from reintervention after one TUITMR was 83.7% and anatomic success after up to two procedures 96.7%; no patient had de novo incontinence, and 12% had complications, mostly urinary tract infections.[5] Dash and Warner (2025) described the UrTrac step: after scar resection the sheath is passed with its obturator, a flexible digital ureteroscope goes down the visual port, and the RD180 with preloaded 2-0 suture places bites that TK Knot fasteners secure, advancing bladder mucosa across the resection bed.[1]

Platform​

The JNW UrTrac is part of an LSI Solutions ecosystem in which the UrTrac provides access, the RD180 places sutures and the Ti-Knot (TK) secures them, designed to perform complete endoscopic urethroplasty without external abdominal or perineal incisions.

References​

1. Dash ME, Warner JN. Detailed surgical technique for endoscopic urethroplasty in the treatment of anastomotic stenosis and bladder neck contracture. Transl Androl Urol. 2025;14(11):3745–3756. doi:10.21037/tau-2025-226

2. LSI Solutions. JNW UrTrac product insert, P/N 081302C, revised May 20, 2025. Four-page US instructions for use.

3. LSI Solutions. JNW URTRAC product page. Manufacturer listing for the 26 Fr model (product code 081300).

4. Abramowitz DJ, Balzano FL, Ruel NH, Chan KG, Warner JN. "Transurethral incision with transverse mucosal realignment for the management of bladder neck contracture and vesicourethral anastomotic stenosis." Urology. 2021;152:102–108. doi:10.1016/j.urology.2021.02.035

5. Curtis J, Schrup S, Moring N, et al. "Transurethral incision with transverse mucosal realignment for the treatment of bladder neck contractures after benign prostate surgery; mid-term outcomes." Urology. 2026. doi:10.1016/j.urology.2026.07.018

See also: RD180 Suturing Device, Ti-Knot Fastener, Bladder Neck Contracture, Vesicourethral Anastomotic Stenosis.