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A presumptive role of lower ureteral angles in the difficulty of ureteral access sheath insertion during retrograde intrarenal surgery

  • Urology - Original Paper
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Abstract

Purpose

We aimed to investigate whether the angle created by the most lateral portion of the lower ureter is responsible for the difficulty in ureteral access sheath insertion.

Methods

All male patients scheduled to undergo flexible ureteroscopy were enrolled. Patients with ureteral stricture in any course of the ureter and patients with problems at the ureteral opening were excluded. We set the coordinates of the most lateral portion of the lower ureter as M (x, y, z) using computed tomography. The bladder outlet was marked as the zero point O (0, 0, 0). The vector that passed through the urethra and point O was expressed as Vuo (0, 0, − u). The vector that passed through points O and M was expressed as Vom (x, y, z). Thus, an angle (90° − α) could be calculated between Vuo and Vom using the rotation angle formula.

Results

A total of 671 male patients were enrolled, among whom the ureteral access sheath could not pass through the most lateral portion of the lower ureter in 14 patients. The mean values of the α angle were 38.56° and 48.48° in the patient and control groups, respectively, compared with the 42 age- and sex-matched control subjects (p < 0.001).

Conclusion

The ureteral angle determined by the level of the bladder outlet and the most lateral portion of the lower ureter could be a causative factor for the failure of ureteral access sheath insertion.

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Acknowledgements

The present study was performed on behalf of the Young Endourological Study (YES) group. The authors would like to thank all the members of the YES group for facilitating project development.

Funding

This research was supported by the Materials and Components Technology Development Program of MOTIE/KETT, Republic of Korea (10067258, Development of a holmium/thulium laser resonator for treatment of prostate hyperplasia).

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Authors and Affiliations

  1. Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea

    Sung Yong Cho & Seung Hoon Ryang

  2. Department of Urology, St. Vincent’s Hospital, The Catholic University of Korea, Jungbudaero 93, Paldal-gu, Suwon, 16247, Republic of Korea

    Dong Sup Lee

Authors
  1. Sung Yong Cho
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  2. Seung Hoon Ryang
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  3. Dong Sup Lee
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Contributions

DSL: project development, data analysis, manuscript writing. SYC: project development, data collection, manuscript editing. SHR: data collection.

Corresponding author

Correspondence to Dong Sup Lee.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The institutional review board at the Seoul Metropolitan Government–Seoul National University Boramae Medical Center approved the observational study design and access to the patients’ medical records (approval number: 16-2015-31).

Informed consent

Written informed consent was obtained from all individual participants included in the study.

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Cho, S.Y., Ryang, S.H. & Lee, D.S. A presumptive role of lower ureteral angles in the difficulty of ureteral access sheath insertion during retrograde intrarenal surgery. Int Urol Nephrol 52, 1657–1663 (2020). https://doi.org/10.1007/s11255-020-02483-1

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  • DOI: https://doi.org/10.1007/s11255-020-02483-1

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