Dose a Ureteral Access Sheath Facilitate Ureteroscopy?

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

doi:10.1097/00005392-200103000-00012

Cited by 55 publications

(75 citation statements)

References 23 publications

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“…However, the impact of UAS on stone-free rates is unclear, as the evidence is very limited. [73][74][75] The effect of UAS use on the ureter is also unclear. It has been demonstrated in animal models that the UAS can induce transient ureteral ischemia and promote an acute inflammatory response in the ureter.…”

Section: Ureteral Access Sheathmentioning

confidence: 99%

CUA Guideline: Management of ureteral calculi

Ordon

Andonian²,

Blew³

et al. 2015

CUAJ

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The focus of this guideline is the management of ureteral stones. Specifically, the topics covered include: conservative management, medical expulsive therapy, active intervention with either shockwave lithotripsy (SWL) or ureteroscopy (URS), factors affecting SWL treatment success, optimizing success, and special considerations (e.g., pregnancy, urinary diversion). By performing extensive literature reviews for each topic evaluated, we have generated an evidence-based consensus on the management of ureteral stones. The objective of this guideline is to help standardize the treatment of ureteral stones to optimize treatment outcomes.

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Section: Ureteral Access Sheathmentioning

confidence: 99%

CUA Guideline: Management of ureteral calculi

Ordon

Andonian²,

Blew³

et al. 2015

CUAJ

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“…15 However, being a tertiary referral centre, more than half of our patients had stents inserted in their parent hospitals, which made access less difficult due to stent induced ureteric dilatation.…”

Section: Discussionmentioning

confidence: 99%

Flexible ureterorenoscopy: prospective analysis of the Guy's experience

Ms¹,

Mf²,

Rc³

et al. 2004

Ann R Coll Surg Engl

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Objective: To report our outcomes with small diameter, actively deflectable flexible ureterorenoscopy from a prospective database. Patients and Methods: 114 flexible ureterorenoscopies were performed in 105 patients (mean age, 49.5 years; range, 19-85 years; 71 males, 34 females) over a 9-month period. Of these, 101 were for refractory stones following failed ESWL and 13 for diagnostic reasons. An Olympus URF P3 flexible ureteroscope with pressure irrigation was used. Electrohydraulic lithotripsy was used to fragment stones and the fragments were retrieved with Graspit, triradiate graspers or tipless baskets. Results: Stents had previously been placed in 53% and dilatation of the ureteric orifice was necessary in 15%. In the stone group, the median operating time was 55 min (range, 15-210 min) and the median screening time 2.2 min (range, 0.3-9.1 min). Success was defined as complete stone clearance or good fragmentation to 2 mm or less. Overall success in this group was 72.3%. There was no statistically significant difference between lower and other calyces (P = 0.83 Chi-square test). Successful outcome was achieved in 72% for stone size 10 mm or less, 80% for 11-20 mm and 50% for greater than 20 mm. Two or more procedures were needed in 8 patients. In the diagnostic group, the median operating time was 45 min (range, 20-60 min) and the median screening time 2 min (range, 0.3-8.3 min). The majority were for upper tract filling defects. Access and successful diagnosis was achieved in all cases. The major complication rate was 2.6%. The ureteroscope needed repair once during this series. Conclusions: Flexible ureterorenoscopy is an effective diagnostic and therapeutic tool in a select group of patients. It should be considered for ESWL-resistant upper tract stones but the results are poor in stones larger than 20 mm and percutaneous nephrolithotomy may be a better option in these patients.

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“…It makes it easier to insert and advance the ureteroscope in the ureter, reducing the risk of trauma when multiple reinsertions of the instrument are required to remove many fragments mechanically. It reduces the intraluminal pressure of the irrigant fluid [6] that may cause the proximal migration of the smaller stone fragments and promote urinary tract infections. It dilates the ureter in a single step, although with modern instruments, this is required in no more than 12-24% of the cases [7,8].…”

Section: Discussionmentioning

confidence: 99%

Expanding Applications of the Access Sheath to Ureterolithotripsy of Distal Ureteral Stones

Sio¹,

Autorino²,

Damiano³

et al. 2004

Urol Int

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Objective: Distal ureteral stones are routinely managed with semirigid ureteroscopy without the need for ureteral dilatation, but some conditions, e.g. large stone burden or difficult catheterization of the ureteral meatus, are time-consuming and would require a tool to facilitate multiple insertions of the ureteroscope and to avoid ureteral injury. An access sheath is now available and it facilitates ureteroscopy of the upper ureter. To answer the question whether its application could be expanded to the distal ureter is the aim of our paper. Patients and Methods: 12 distal ureteral stone patients, 8 with stone size >1 cm and 4 with a large prostate, underwent ballistic ureterolithotripsy with the aid of the Access Sheath. The results of the procedure were compared to a second group of 16 patients from our archives. Results: There was no significant difference in operating time and stone-free rate. Although no complications were related to the ureteroscopy, in 42% (5 patients) of the access group the procedure could be completed only after removing the sheath. Conclusion: The Access Sheath does not improve the results of the semirigid ureteroscopy of difficult stones in the distal ureter.

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Dose a Ureteral Access Sheath Facilitate Ureteroscopy?

Cited by 55 publications

References 23 publications

CUA Guideline: Management of ureteral calculi

CUA Guideline: Management of ureteral calculi

Flexible ureterorenoscopy: prospective analysis of the Guy's experience

Expanding Applications of the Access Sheath to Ureterolithotripsy of Distal Ureteral Stones

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