Is stenting required before retrograde intrarenal surgery with access sheath

Abstract

Background:Flexible ureterorenoscopies continue to assume an increasing role in the armamentarium of the endourologist. In many centers around the world, prior stenting is carried out before retrograde intrarenal surgery (RIRS) to passively dilate the ureter, which facilitates passage of a flexible ureteroscope with or without an access sheath. In our series, the first stage of passive dilatation with prior stenting was totally avoided without compromising the success of the procedure.Materials and Methods:From January 2004 to December 2007, 54 patients with 55 renal units underwent RIRS. The patients were between 28 and 65 years old. All patients had renal stones ranging in size from 8 mm to 22 mm. The mean serum creatinine level was 1.1 mg%. The lower ureter was dilated under ‘C - arm’ fluoroscopy guidance up to 14 FR. An access sheath of 10/12 Fr was passed over the working guide wire. RIRS (7.5/9.3 Fr) was introduced into the access sheath. The stones were fragmented using a holmium laser. The mean operating time was 85 mins (45-130 mins).Results:In 52 out of 55 renal units (94.5%), a flexible ureteroscope could be passed successfully into the kidney through an access sheath. In 3 of the cases (5.4%), the lower ureter could not be dilated. In these patients, the procedure was staged after passing a 6/26 JJ stent. An X-ray KUB was done at the 3-month follow-up visit. A total of 50 renal units (94.3%) were stone free at the 3-month follow-up visit.Conclusion:In a majority of the cases, RIRS could be accomplished successfully during the first sitting. Single stage RIRS did not alter the subsequent stone clearance or increase the incidence of morbidity or complications.

Flexible ureteroscopy for renal stone without preoperative ureteral stenting shows good prognosis

“…However, most studies were referred to patients with ureteral and renal calculi, and instruments and methods applied for ureteral calculi are quite different from renal calculi. In addition, fURS occasionally will not pass beyond the ureter to reach renal pelvis, which have been mentioned limitedly (Ambani et al, 2013; Mahajan et al, 2009; Cetti, Biers & Keoghane, 2011). Therefore, the aim of this study was to systematically clarify the surgical outcome of fURS without preoperative stenting for renal calculi.…”

Complications of Endourologic Procedures: A Review on Iatrogenic Ureteral Perforation

“…Particularly the placement of a preoperative double-J stent for sheath procedures reduces the risk of severe ureteral lesion by seven fold, including perforation [19] . However, despite the benefits found with the passive dilatation of double-J stents, their routine use is not recommended, as it is not cost-effective and is associated with a deterioration in patients' quality of life [30,31] . Regarding flexible ureteroscopy procedures with and without ureteral access sheath, there is no significant difference in perforation incidence, being the percentages 1.1% and 1.2% respectively [32,33] .…”

The Novel Use of Flexible Ureteroscopy and Holmium: YAG Laser in the Management of Parapelvic Renal Cysts

“…15,16 Some authors 10,16 carried out ureteral stenting prior to the surgery about 1-2 weeks to passively dilate the ureter in order to attain smooth ureteral passage during the surgery, while other authors performed the procedure without prior stenting. According to Mahajan et al, 18 during RIRS (retrograde intrarenal surgery) reported that first setting flexible ureteroscope can reach to the kidney without prior ureter stenting, they have found that 94.5% success can be achieved when ureter access sheath is used. To prevent possible infections, prophylaxis antibiotics should be given to the patients before the surgery undertaken.…”