Safety And Efficacy of Ureteral Access Sheaths

Abstract

The ureteral access sheath (UAS) was introduced as a means of passing a flexible ureteroscope. Although the device was initially lauded for its ability to facilitate ureteroscopic access, passage was difficult and risked ureteral injury, and the UAS fell out of favor until the development of a new generation of devices that was easier to insert. The UAS should be advanced under fluoroscopy over a stiff guidewire, and the surgeon should ensure copious hydration of all inner and outer surfaces. Use of the UAS is purported to improve irrigant flow and visibility. The UAS can induce transient ureteral ischemia and promote an acute inflammatory response, but it also prevents potentially harmful elevations in intrarenal pressure. Unequivocal data are not yet available to suggest that UAS use during ureteroscopy protects or harms the upper urinary tract. The UAS also has the potential to improve stone-free rates by allowing passive egress or active retrieval of fragments. A large prospective study is needed to unequivocally determine if UAS use is superior in terms of stone-free rates. Cost studies reported to favor UAS use, although a formal cost-effectiveness analysis has not been performed. Further study is needed before routine use of the UAS can be recommended.

Flexible ureterorenoscopy results: Analysis of 279 cases

“…The potential infections should be treated with appropriate antibiotics, and the procedure should be conducted after sterilization of urine. [21] In our study, since all patients received appropriate antibiotic prophylaxis, a serious infection was not encountered in our patients. Only 3 patients had high fever at postoperative first day which was relieved with appropriate antibiotherapy.…”

The new concept of ureteral access sheath with guidewire disengagement: One wire does it all

“…While permitting fast and multiple re-entries to the upper urinary tract, it reduces damage to the ureteroscope, decreases the intraluminal pressure during the procedure and allows drainage and elimination of dust and stone fragments [1][2][3]6]. On the other hand, UAS use has been associated with risk of ureteral injury.…”

“…Furthermore, avoidance of using a second guidewire could potentially reduce the cost of the procedure that may be especially expensive in high volume centers [12]. Although cost studies are prone to support the use of UAS [13], it is known that the use of additional equipment increases fURS expenses. Since costs vary highly among different countries, cost analysis studies may not be uniform, although cost models based in the UK [12] and Turkey [14] reported an added cost of up to $38 for each guidewire use.…”

“…The use of UAS is believed to reduce damage to the ureteroscope during repeated passages of the instrument. Furthermore, UAS use has been shown to decrease the intraluminal pressure during fURS and permit drainage and elimination of dust and stone fragments, which may decrease operative time and costs [1][2][3]. UAS must be carefully inserted, since they may cause ureteral lesions due to over distension and false passage [4].…”

Efficacy of flexible fibreoptic ureteroscopy and Holmium laser in retrograde intrarenal surgery for calyceal calculi

“…Our aim was to have 100% clearance but in those with a narrow long infundibulum leading to the inferior calyx, residual fragments persisted radiologically. We used double J stents placed preoperatively to passively dilate the ureter and used access sheaths in all cases as recommended by Stern et al [21][22][23] We used the 165 μ laser fibre which did not affect deflection of the scope. The 200 μ fibre was seen to decrease deflection by almost 30°.…”