An expandable medical sheath is configured to be introduced into a body in a first, low cross-sectional area configuration, and expanded to a second, enlarged cross-sectional configuration. The sheath is maintained in the first, low cross-sectional configuration by structures or elements within the sheath wall that maintain a collapsed shape. Upon expansion with a dilator, the sheath maintains a second, enlarged cross-sectional configuration by elements or structures within the sheath tubing wall that resist re-collapse. The sheath includes a nose cone or tapered fairing to deflect tissue from entering the collapsed distal end of the sheath during introduction. The fairing collapses following expansion and subsequent deflation of the dilator, thus allowing the tapered fairing to be withdrawn proximally through the central lumen of the sheath. In one application, the sheath is utilized to provide access for a diagnostic or therapeutic procedure such as percutaneous nephrostomy or urinary bladder access.