Increasing the size of ureteral access sheath during retrograde intrarenal surgery improves surgical efficiency without increasing complications
To directly compare intraoperative and post-operative outcomes and complications between three groups undergoing ureteroscopy: no ureteral access sheath, 12/14 Fr and larger 14/16 Fr ureteral access sheaths (UAS).
We retrospectively reviewed demographic, pre-operative, intraoperative, and post-operative data of 257 patients who underwent ureteroscopy for nephrolithiasis by a single surgeon from January 2013 through July 2015. Patients were separated into three groups: no UAS, a 12/14 Fr UAS, or 14/16 Fr UAS. Outcomes included differences in stone-free rate, post-procedure-related events (PRE), ureteral injury rate (measured by early post-operative hydronephrosis), and post-operative complications.
A UAS was used in 65.4% (168/257) patients, with 73.8% (124/168) utilizing a 12/14 Fr UAS and 26.2% (44/168) utilizing a 14/16 Fr UAS. Those patients in whom a 14/16 Fr UAS was employed had greater stone burden compared to the 12/14 Fr UAS group (180.8 ± 18.0 vs. 104 ± 9.1 mm2, p < 0.001). When comparing 12/14 Fr and 14/16 Fr ureteral access sheaths, there was no significant difference in ureteral injury rate, complications (10.5 vs. 11.4%, respectively; p = 0.87), or overall stone-free rate (78.1 vs. 81.3%, p = 0.70). The mean amount of stone burden treated per minute of operative time was more than 30% higher in the 14/16 Fr UAS group compared to 12/14 Fr UAS group (2.11 vs. 1.62 mm2/min; p = 0.01).
The use of a 14/16 Fr UAS allows for similar stone-free rate and improved operative efficiency with no increased risk of ureteral injury or post-operative complications when compared to the 12/14 Fr UAS.
KeywordsNephrolithiasis Surgical instruments Complications Ureteroscopy
CRT project development and manuscript writing/editing, GMG protocol/project development, data collection or management, data analysis, and manuscript writing/editing, CJP data collection or management and data analysis, NAB protocol/project development, data collection or management, data analysis, and manuscript writing/editing.
Funding for this study was received through the Watts Family Fellowship in Urologic Research.
- 2.Bader MJ, Gratzke C, Walther S, Weidlich P, Staehler M, Seitz M, Sroka R, Reich O, Stief CG, Schlenker B (2010) Efficacy of retrograde ureteropyeloscopic holmium laser lithotripsy for intrarenal calculi > 2cm. Urol Res 38:397–402. https://doi.org/10.1007/s00240-010-0258-5 CrossRefPubMedGoogle Scholar
- 16.L’Esperance JO, Ekeruo WO, Scales CD Jr, Marguet CG, Springhart WP, Maloney ME, Albala DM, Preminger GM (2005) Effect of ureteral access sheath on stone-free rates in patients undergoing ureteroscopic management of renal calculi. Urology 66:252–255. https://doi.org/10.1016/j.urology.2005.03.019 CrossRefPubMedGoogle Scholar
- 17.Traxer O, Wendt-Nordahl G, Sodha H, Rassweiler J, Meretyk S, Tefekli A, Coz F, de la Rosette JJ (2015) 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 33:2137–2144. https://doi.org/10.1007/s00345-015-1582-8 CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Ito H, Kawahara T, Terao H, Ogawa T, Yao M, Kubota Y, Matsuzaki J (2013) Evaluation of preoperative measurement of stone surface area as a predictor of stone-free status after combined ureteroscopy with holmium laser lithotripsy: a single-center experience. J Endourol 27:715–721. https://doi.org/10.1089/end.2012.0548 CrossRefPubMedGoogle Scholar
- 24.Ito H, Kawahara T, Terao H, Ogawa T, Yao M, Kubota Y, Matsuzaki J (2012) The most reliable preoperative assessment of renal stone burden as a predictor of stone-free status after flexible ureteroscopy with holmium laser lithotripsy: a single-center experience. Urology 80:524–528. https://doi.org/10.1016/j.urology.2012.04.001 CrossRefPubMedGoogle Scholar