Dose a Ureteral Access Sheath Facilitate Ureteroscopy?

Kourambas, John; Byrne, Robert R.; Preminger, Glenn M.

doi:10.1016/s0022-5347(05)66527-5

Cited by 237 publications

(76 citation statements)

References 25 publications

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“…Perioperative antibiotics can be appropriately tailored to culture-specific organisms. Ureteral access sheaths are useful adjuncts to URS that allow safe, repeated insertion and withdrawal of a ureteroscope [15,16]. Access sheaths also allow for continuous irrigation of the renal pelvis and improved stone clearance, as well as lower renal pelvic pressures that may be protective against pyelovenous and pyelolymphatic backflow [17,18].…”

Section: Discussionmentioning

confidence: 99%

Complications of Flexible Ureteroscopic Treatment for Renal and Ureteral Calculi during the Learning Curve

Komori¹,

Ishikawa²,

Daizumoto³

et al. 2015

Urol Int

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Background: The flexible ureterorenoscope (URS) and associated devices have developed rapidly. However, despite its therapeutic benefits, URS may be associated with some complications. To the best of our knowledge, there are no studies discussing the complications of flexURS during the learning curve. Methods: A retrospective review of the records of patients who underwent flexURS from January 2005 to June 2013 was performed. To compare the complications after the introduction of flexURS, patients were divided into four groups based on the surgeon's training experience, that is, based on the number of cases performed by the surgeon. A total of 219 cases underwent flexURS. Groups 1, 2, 3, and 4 included 35, 50, 50, and 84 cases, respectively. The complications were classified using the Clavien system (I-IV). Results: The mean operation time and stone-free rate were significantly different (p < 0.001, p = 0.013, respectively). The total complication rates were 13.6, 10, 8.3, and 3.2%, respectively (p = 0.068). The more the surgeon's experience, the less was the complication rate. Despite our best efforts, the incidence of urosepsis was not reduced (p = 0.902). Conclusions: To reduce severe complications, it is necessary to have performed about 100 cases. Increased surgeon experience tended to decrease the risk of severe complications, but the incidence of urosepsis was not reduced.

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Section: Discussionmentioning

confidence: 99%

Complications of Flexible Ureteroscopic Treatment for Renal and Ureteral Calculi during the Learning Curve

Komori¹,

Ishikawa²,

Daizumoto³

et al. 2015

Urol Int

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“…[23] Access sheaths have been used to facilitate recurrent entries into, and exits from renal collecting systems. In a study where effectiveness of these access sheaths was evaluated, its routine intraoperative use during RIRC was recommended in that it decreases costs, and duration of operations, and causes minimal morbidity.…”

Section: Discussionmentioning

confidence: 99%

Flexible ureterorenoscopy results: Analysis of 279 cases

Elbir

Basibuyuk

Topaktaş

et al. 2015

Turkish Journal of Urology

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Objective: In this study, the outcomes of 279 cases in whom we performed retrograde intrarenal surgery (RIRS) were evaluated retrospectively. Material and methods:RIRS was performed on 279 cases with the aid of access sheath of guidewire between March 2011 and February 2015. All patients were operated in the standard lithotomy position. A hydrophilic guidewire was inserted with the aid of rigid ureterorenoscopy and we checked whether there were any residual ureteral stones and other pathologies. Fluoroscopy was used routinely in all cases. Stone fragments smaller than 3 mm were left off but those bigger than 3 mm were removed by grasper after stone fragmentation. Controls of the patients were assessed by plain films (KUB), urinary tract ultrasonography (US) and/or computed tomography (CT) 1 month after the operation. Success rate of the procedure was defined as the stone-free status or presence of residual fragments less than 3 mm.Results: 152 of the patients were male and 127 were female. The median ages of the male and female patients were 47.7 (1-86) ve 45.9 (3-79) years respectively. The median stone size was 13.5 mm (8-25). Preoperatively 34 (12.1%) patients had double-J ureteral stent. 19 (6.8%) patients were operated while they were still receiving antithrombotic and antiplatelet therapy Solitary kidney was present in 24 patients while the remaining patients had kyphoscoliosis (n=3), rotation anomaly (n=6), pelvic kidney (n=2), double collecting system (n=3), and horseshoe kidney (n=6). In 264 patients access sheath was used, in 15 patients operation was performed with the help of the guidewire. Double-J stents were inserted to 14 patients because of ureteral stricture and they underwent operation after 2 weeks later. Renal stones of 219 patients among all cases were fragmented completely and the patients were discharged as stone free (SF). Our success rate (SF or presence of clinically insignificant residual [CIRF]) was 78.4%. Stone size (p= 0.029), stone number (p= 0.01), stone location (p= 0.023) had significant influence on the stone-free rate after RIRS The mean operation and floroscopy time was 62.5 min. (40-180) and 29.8 sec (4-96), respectively. The mean hospitalization time was 26.4 hours (12-72). Double J stents were placed to 253 patients for more stone burden and ureteral edema. Any complication was not observed for all cases except perioperative developed infection for two patients. Conclusion:With advances in laser technology and flexible ureterorenoscopy, kidney stones can be treated with lower morbidity and high success rates.

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“…Modern flexible ureterorenoscopes may access all pelvicaliecal system including lower pole, and Holmium Laser provides effective stone fragmentation regardless of stone type. Additionally, use of ureteral access sheath facilitate the passage of stone fragments, which improves patients quality of life after the procedure (4). Many authors had achieved up to 90% stone free rates with acceptable complications in f-URS procedure in moderate sized stones (5, 6).…”

Section: Introductionmentioning

confidence: 99%

Is there a difference between presence of single stone and multiple stones in flexible ureterorenoscopy and laser lithotripsy for renal stone burden <300mm2?

et al. 2016

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In this study, we aim to evaluate and compare the effectiveness of flexible ureterorenoscopy (f-URS) for solitary and multiple renal stones with <300 mm2 stone burden. Patients' charts who treated with f-URS for kidney stone between January 2010 and June 2015 were reviewed, retrospectively. Patients with solitary kidney stones (n:111) were enrolled in group 1. We selected 111 patients with multiple kidney stones to serve as the control group and the patients were matched at a 1:1 ratio with respect to the patient's age, gender, body mass index and stone burden. Additionally, patients with multiple stones were divided into two groups according to the presence or abscence of lower pole stones. Stone free status was accepted as complete stone clearence and presence of residual fragments < 2 mm. According to the study design; age, stone burden, body mass index were comparable between groups. The mean operation time was longer in group 2 (p= 0.229). However, the mean fluoroscopy screening time in group 1 and in group 2 was 2.1±1.7 and 2.6±1.5 min, respectively and significantly longer in patients with multiple renal stones (P=0.043). The stone-free status was significantly higher in patients with solitary renal stones after a single session procedure (p=0.02). After third month follow up, overall success rate was 92.7% in Group 1 and 86.4% in Group 2. Our study revealed that F-URS achieved better stone free status in solitary renal stones <300 mm2. However, outcomes of F-URS were acceptable in patients with multiple stones.

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Dose a Ureteral Access Sheath Facilitate Ureteroscopy?

Cited by 237 publications

References 25 publications

Complications of Flexible Ureteroscopic Treatment for Renal and Ureteral Calculi during the Learning Curve

Complications of Flexible Ureteroscopic Treatment for Renal and Ureteral Calculi during the Learning Curve

Flexible ureterorenoscopy results: Analysis of 279 cases

Is there a difference between presence of single stone and multiple stones in flexible ureterorenoscopy and laser lithotripsy for renal stone burden <300mm2?

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