Is 10/12 Fr Ureteral Access Sheath more Suitable for Flexible Ureteroscopic Lithotripsy?
23 February 2021
Purpose: To choose the ideal UAS size for an unstented ureter in flexible ureteroscopic lithotripsy.
Materials and Methods: A retrospective case-control study was conducted with patients treated with flexible ureteroscopic lithotripsy for renal calculi from 2005 to 2020. The patients were divided into two groups: smaller (10/12 Fr) vs. larger (12/14 Fr) calibre UAS. The outcome was the insertion success rate, systemic inflammatory response syndrome (SIRS) complication rate after the operation, ureteral wall injury, operative time, and stone-free rate.
Results: Of the 1573 patients enrolled, 10/12 Fr UAS was used in 957 (Group A); 12/14 Fr UAS was used in the remaining patients (Group B). The insertion success rate was significantly better in Group A (91.2% vs. 86.9%, P = .006), with no significant difference between the groups regarding the stone-free rate, postoperative pain, operative time and hospital stay. The severity of ureteral visible lesions with 10/12 Fr UAS was significantly lower than that with larger UASs (80.1% vs 85.2%, P = .000). Despite no significant difference in the incidence of SIRS between the two groups, the incidence of SIRS in the 10/12 Fr group showed a sharp increase with stones >2 cm (17.0% vs. 8.5%, P = 0.037).
Conclusion: The use of 10/12 Fr UAS had an advantage for the insertion success rate, avoiding ureteral wall injury and not increasing postoperative infectious complications in flexible ureteroscopic lithotripsy. We recommend the use of smaller calibre (10/12 Fr) UAS in patients with renal calculi < 2 cm.
- Ureteral access sheath
- Infectious complications
How to Cite
2. Ozgor F, Sahan M, Cubuk A, Ortac M, Ayranci A, Sarilar O. Factors affecting infectious complications following flexible ureterorenoscopy. Urolithiasis. 2019;47:481-486.
3. Tokas T, Skolarikos A, TRW H, Nagele U. Pressure matters 2: intrarenal pressure ranges during upper-tract endourological procedures. World J Urol. 2019;37:133-142.
4. Tracy CR, Ghareeb GM, Paul CJ, Brooks NA. Increasing the size of ureteral access sheath during retrograde intrarenal surgery improves surgical efficiency without increasing complications. World J Urol. 2018;36:971-978.
5. Shvero A, Herzberg H, Zilberman D, et al. Is it safe to use a ureteral access sheath in an unstented ureter. BMC Urol. 2019;19:80.
6. Traxer O, Wendt-Nordahl G, Sodha H, et al. Differences in renal stone treatment and outcomes for patients treated either with or without the support of a ureteral access sheath: The Clinical Research Office of the Endourological Society Ureteroscopy Global Study. World J Urol. 2015;33:2137-2144.
7. Fuller TW, Rycyna KJ, Ayyash OM, et al. Defining the Rate of Primary Ureteroscopic Failure in Unstented Patients: A Multi-Institutional Study. J Endourol. 2016;30:970-974.
8. Lildal SK, Sørensen FB, Andreassen KH, et al. Histopathological correlations to ureteral lesions visualized during ureteroscopy. World J Urol. 2017;35:1489-1496.
9. Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol. 2013;189:580-584.
10. Lima A, Reeves T, Geraghty R, et al. Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period. World J Urol. 2020;38:1329-1333.
11. Kuntz NJ, Neisius A, Tsivian M, et al. Balloon Dilation of the Ureter: A Contemporary Review of Outcomes and Complications. J Urol. 2015;194:413-417.
12. Humphreys MR, Shah OD, Monga M, et al. Dusting versus Basketing during Ureteroscopy-Which Technique is More Efficacious? A Prospective Multicenter Trial from the EDGE Research Consortium. J Urol. 2018;199:1272-1276.
13. Matlaga BR, Chew B, Eisner B, et al. Ureteroscopic Laser Lithotripsy: A Review of Dusting vs Fragmentation with Extraction. J Endourol. 2018;32:1-6.
14. Santiago JE, Hollander AB, Soni SD, et al. To Dust or Not To Dust: a Systematic Review of Ureteroscopic Laser Lithotripsy Techniques. Curr Urol Rep. 2017;18:32.
15. Sener TE, Cloutier J, Villa L, et al. Can We Provide Low Intrarenal Pressures with Good Irrigation Flow by Decreasing the Size of Ureteral Access Sheaths. J Endourol. 2016;30:49-55.
16. Gao X, Lu C, Xie F, et al. Risk factors for sepsis in patients with struvite stones following percutaneous nephrolithotomy. World J Urol. 2020;38:219-229.
17. Fang L, Xie G, Zheng Z, et al. The Effect of Ratio of Endoscope-Sheath Diameter on Intrapelvic Pressure During Flexible Ureteroscopic Lasertripsy. J Endourol. 2019;33:132-139.
18. Noureldin YA, Kallidonis P, Ntasiotis P, et al. The Effect of Irrigation Power and Ureteral Access Sheath Diameter on the Maximal Intra-Pelvic Pressure During Ureteroscopy: In Vivo Experimental Study in a Live Anesthetized Pig. J Endourol. 2019;33:725-729.
19. Williams JG, Turney BW, Rauniyar NP, et al. The Fluid Mechanics of Ureteroscope Irrigation. J Endourol. 2019;33:28-34.
20. Loftus CJ, Ganesan V, Traxer O, et al. Ureteral Wall Injury with Ureteral Access Sheaths: A Randomized Prospective Trial. J Endourol. 2020;34:932-936.
21. Lildal SK, Andreassen KH, Jung H, et al. Evaluation of ureteral lesions in ureterorenoscopy: impact of access sheath use. Scand J Urol. 2018;52:157-161.
22. Lildal SK, Nørregaard R, Andreassen KH, et al. Ureteral Access Sheath Influence on the Ureteral Wall Evaluated by Cyclooxygenase-2 and Tumor Necrosis Factor-α in a Porcine Model. J Endourol. 2017;31:307-313.
23. Huang J, Zhao Z, AlSmadi JK, et al. Use of the ureteral access sheath during ureteroscopy: A systematic review and meta-analysis. PLoS One. 2018;13:e0193600.
24. Oğuz U, Şahin T, Şenocak Ç, et al. Factors associated with postoperative pain after retrograde intrarenal surgery for kidney stones. Turk J Urol. 2017;43:303-308.
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