Ureteroscopy pp 137-143 | Cite as

Ureteral Access Sheaths

  • Kendall J. FeiaEmail author
  • Branden G. Duffey
  • J. Kyle Anderson
Part of the Current Clinical Urology book series (CCU)


Accompanying the development of more modern endoscopes in the 1970s and 1980s were technologies developed to further facilitate retrograde access to the upper urinary tract. The ureteral access sheath (UAS) has proven to be a useful adjunct in ureteroscopy. By simplifying repeated access to the upper urinary tract, the UAS has been shown to streamline ureteroscopy and decrease operative time and cost. Furthermore, it has been associated with lower intrarenal pressures, decreased damage to operative equipment, and improved stone free rates following ureteroscopy. Studies have also shown that the rates of ureteral stricture are not increased with their use, even though they have been shown to reduce ureteral blood flow, and require the placement of a ureteral stent afterward. With their expanding use, surgeons are now utilizing this tool as an adjunct in the treatment of upper tract urothelial cell carcinoma. The objective of this chapter is to provide a review of the current literature available regarding the UAS. This chapter will specifically address UAS construction and physical properties, purported benefits, potential complications, and uses in treating upper urinary tract pathology.


Stone Free Rate Ureteral Stricture Outer Sheath Ureteral Dilation Ureteral Access Sheath 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Takayasu H, Aso Y. Recent development for pyeloureteroscopy: guide tube method for its introduction into the ureter. J Urol. 1974;112(2):176–8.PubMedGoogle Scholar
  2. 2.
    Kourambas J, Byrne RR, Preminger GM. Does a ureteral access sheath facilitate ureteroscopy? J Urol. 2001;165(3):789–93.PubMedCrossRefGoogle Scholar
  3. 3.
    Monga M, Bhayani S, Landman J, Conradie M, Sundaram CP, Clayman RV. Ureteral access for upper urinary tract disease: the access sheath. J Endourol. 2001;15(8):831–4.PubMedCrossRefGoogle Scholar
  4. 4.
    Auge BK, Pietrow PK, Lallas CD, Raj GV, Santa-Cruz RW, Preminger GM. Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol. 2004;18(1):33–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Landman J, Venkatesh R, Ragab M, Rehman J, Lee DI, Morrissey KG, Monga M, Sundaram CP. Comparison of intrarenal pressure and irrigant flow during percutaneous nephroscopy with an indwelling ureteral catheter, ureteral occlusion balloon, and ureteral access sheath. Urology. 2002;60(4):584–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Rehman J, Monga M, Landman J, Lee DI, Felfela T, Conradie MC, Srinivas R, Sundaram CP, Clayman RV. Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology. 2003;61(4):713–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Monga M, Best S, Venkatesh R, Ames C, Lee C, Kuskowski M, Schwartz S, Vanlangendock R, Skenazy J, Landman J. Durability of flexible ureteroscopes: a randomized, prospective study. J Urol. 2006;176(1):137–41.PubMedCrossRefGoogle Scholar
  8. 8.
    L’esperance JO, Ekeruo WO, Scales Jr CD, Marguet CG, Springhart WP, Maloney ME, Albala DM, Preminger GM. Effect of ureteral access sheath on stone-free rates in patients undergoing ureteroscopic management of renal calculi. Urology. 2005;66(2):252–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Harper JD, Ebrahimi KY, Auge BK, Lamberton GR, Pham AK, Zuppan C, Albala DM, Preminger GM, Baldwin DD. Comparison of a novel radially dilating balloon ureteral access sheath to a conventional sheath in the porcine model. J Urol. 2008;179(5):2042–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Gaylis F, Bastuba M, Bidair M, Friedel W. Ureteral dilation using a tapered dilator: a cost-effective approach. J Endourol. 2000;14(5):447–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Pedro R, Hendlin K, Durfee W, Monga M. Physical characteristics of next-generation ureteral access sheaths: buckling and kinging. Urology. 2007;70(3):440–2.PubMedCrossRefGoogle Scholar
  12. 12.
    Borboroglu PG, Amling CL, Schenkman NS, Monga M, Ward JF, Piper NY, Bishoff JT, Kane CJ. Ureteral stenting after ureteroscopy for distal ureteral calculi: a multi-institutional prospective randomized controlled study assessing pain, outcomes and complications. J Urol. 2001;166(5):1651–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Schwalb DM, Eshghi M, Davidian M, Franco I. Morphological and physiological changes in the urinary tract associated with ureteral dilation and ureteropyeloscopy: an experimental study. J Urol. 1993;149(6):1576–85.PubMedGoogle Scholar
  14. 14.
    Afane JS, Olweny EO, Bercowsky E, Sundaram CP, Dunn MD, Shalhav AL, McDougall EM, Clayman RV. Flexible ureteroscopes: a single center evaluation of the durability and function of the new endoscopes smaller than 9Fr. J Urol. 2000;164(4):1164–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Pietrow PK, Auge BK, Delvecchio FC, Silverstein AD, Weizer AZ, Albala DM, Preminger GM. Techniques to maximize flexible ureteroscope longevity. Urology. 2002;60(5):784–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Bilgasem S, Pace KT, Dyer S, Honey RJ. Removal of asymptomatic ipsilateral renal stones following rigid ureteroscopy for ureteral stones. J Endourol. 2003;17(6):397–400.PubMedCrossRefGoogle Scholar
  17. 17.
    Chow GK, Patterson DE, Blute ML, Segura JW. Ureteroscopy: effect of technology and technique on clinical practice. J Urol. 2003;170(1):99–102.PubMedCrossRefGoogle Scholar
  18. 18.
    Harmon WJ, Sershon PD, Blute ML, Patterson DE, Segura JW. Ureteroscopy: current practice and long-term complications. J Urol. 1997;157(1):28–32.PubMedCrossRefGoogle Scholar
  19. 19.
    Schuster TG, Hollenbeck BK, Faerber GJ, Wolf JS. Ureteroscopic treatment of lower pole calculi: comparison of lithotripsy in situ and after displacement. J Urol. 2002;168(1):43–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Sofer M, Watterson JD, Wollin TA, Nott L, Razvi H, Denstedt JD. Holmium:YAG laser lithotripsy for upper urinary tract calculi in 598 patients. J Urol. 2002;167(1):31–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Delvecchio FC, Auge BK, Brizuela RM, Weizer AZ, Silverstein AD, Lallas CD, Pietrow PK, Albala DM, Preminger GM. Assessment of stricture formation with the ureteral access sheath. Urology. 2003;61(3):518–22. discussion 522.PubMedCrossRefGoogle Scholar
  22. 22.
    Haleblian G, Kijvikia K, Rosetta J, Preminger G. Ureteral stenting and urinary stone management: a systematic review. J Urol. 2008;179(2):424–30.PubMedCrossRefGoogle Scholar
  23. 23.
    El-Nahas AR, El-Assmy AM, Shoma AM, Eraky I, El-Kenawy MR, El-Kappany HA. Self-retaining ­ureteral stents: analysis of factors responsible for patients’ discomfort. J Endourol. 2006;20(1):33–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Rane A, Saleemi A, Cahill D, Sriprasad S, Shrotri N, Tiptaft R. Have stent-related symptoms anything to do with placement technique? J Endourol. 2001;15(7):741–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Cheung MC, Lee F, Leung YL, Wong BB, Tam PC. A prospective randomized controlled trial on ureteral stenting after ureteroscopic holmium laser lithotripsy. J Urol. 2003;169(4):1257–60.PubMedCrossRefGoogle Scholar
  26. 26.
    Rapoport D, Perks AE, Teichman JM. Ureteral access sheath use and stenting in ureteroscopy: effect on unplanned emergency room visits and cost. J Endourol. 2007;21(9):993–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Lallas CD, Auge BK, Raj GV, Santa-Cruz R, Madden JF, Preminger GM. Laser doppler flowmetric determination of ureteral blood flow after ureteral access sheath placement. J Endourol. 2002;16(8):583–90.PubMedCrossRefGoogle Scholar
  28. 28.
    Abdel-Razzak OM, Bagley DH. Clinical experience with flexible ureteropyeloscopy. J Urol. 1992;148(6):1788–92.PubMedGoogle Scholar
  29. 29.
    Elashry OM, Elbahnasy AM, Rao GS, Nakada SY, Clayman RV. Flexible ureteroscopy: Washington University experience with the 9.3 F and 7.5 F flexible ureteroscopes. J Urol. 1997;157(6):2074–80.PubMedCrossRefGoogle Scholar
  30. 30.
    Francesca F, Scattoni V, Nava L, Pompa P, Grasso M, Rigatti P. Failures and complications of transurethral ureteroscopy in 297 cases: conventional rigid instruments vs. small caliber semirigid ureteroscopes. Eur Urol. 1995;28(2):112–5.PubMedGoogle Scholar
  31. 31.
    Geavlete P, Georgescu D, Niţă G, Mirciulescu V, Cauni V. Complications of 2735 retrograde semirigid ureteroscopy procedures: a single-center experience. J Endourol. 2006;20(3):179–85.PubMedCrossRefGoogle Scholar
  32. 32.
    Vanlangendonck R, Landman J. Ureteral access strategies: pro-access sheath. Urol Clin North Am. 2004;31(1):71–81.PubMedCrossRefGoogle Scholar
  33. 33.
    Keeley FX, Kulp DA, Bibbo M, McCue PA, Bagley DH. Diagnostic accuracy of ureteroscopic biopsy in upper tract transitional cell carcinoma. J Urol. 1997;157(1):33–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Tavora F, Fajardo DA, Lee TK, Lotan T, Miller JS, Miyamoto H, Epstein JI. Small endoscopic biopsies of the ureter and renal pelvis: pathologic pitfalls. Am J Surg Pathol. 2009;33(10):1540–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Gorin MA, Santos Cortes JA, Kyle CC, Carey RI, Bird VG. Initial clinical experience with use of ureteral access sheaths in the diagnosis and treatment of upper tract urothelial carcinoma. Urology. 2011;78(3):523–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Wason S, Schned A, Seigne J, Pais V. Evaluation of adequacy of pathologic specimens using a novel backloading ureteroscopic biopsy forceps. J Urol. 2010;183(4):e354–5.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Kendall J. Feia
    • 1
    Email author
  • Branden G. Duffey
    • 2
  • J. Kyle Anderson
    • 1
  1. 1.Department of UrologyUniversity of MinnesotaMinneapolisUSA
  2. 2.Urology Division, Surgery DepartmentSan Antonio Military Medical CenterSan AntonioUSA

Personalised recommendations