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Increasing the size of ureteral access sheath during retrograde intrarenal surgery improves surgical efficiency without increasing complications

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Abstract

Purpose

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).

Methods

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.

Results

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).

Conclusion

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.

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Funding

Funding for this study was received through the Watts Family Fellowship in Urologic Research.

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Authors and Affiliations

  1. Department of Urology, University of Iowa, 200 Hawkins Dr., 3 RCP, Iowa City, IA, 52242-1089, USA

    Chad R. Tracy, George M. Ghareeb, Charles J. Paul & Nathan A. Brooks

Authors
  1. Chad R. Tracy
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  2. George M. Ghareeb
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  3. Charles J. Paul
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  4. Nathan A. Brooks
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Contributions

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.

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Correspondence to Chad R. Tracy.

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Tracy, C.R., Ghareeb, G.M., Paul, C.J. et al. Increasing the size of ureteral access sheath during retrograde intrarenal surgery improves surgical efficiency without increasing complications. World J Urol 36, 971–978 (2018). https://doi.org/10.1007/s00345-018-2204-z

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  • DOI: https://doi.org/10.1007/s00345-018-2204-z

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