Safety and Outcomes of using ureteric access sheath (UAS) for treatment of Pediatric renal stones: Outcomes from 2 tertiary endourology centers

Mosquera, Lucía; Pietropaolo, Amelia; Brewin, Anna; Madarriaga, Yesica Quiroz; Knecht, EL de; Jones, Patrick; Bujons, Anna; Griffin, Stephen; Somani, B.

doi:10.1016/j.urology.2021.04.011

Cited by 15 publications

(26 citation statements)

References 16 publications

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“…Despite of an increased endoscopically identified risk of high-grade ureteral injuries with a 12/14 Fr UAS, there was no difference in ureteral stricture formation after one year follow-up [ 34 ]. Similar findings were published in two other retrospective studies on adults [ 37 , 38 ] and one in 48 children over a mean follow-up of 17 months [ 39 ].…”

Section: Resultssupporting

confidence: 89%

Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review

Coninck

Somani

Şener

et al. 2022

JCM

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Ureteral access sheaths (UASs) are part of urologist’s armamentarium when performing retrograde intrarenal surgery (RIRS). Recently, the world of RIRS has changed dramatically with the development of three game-changers: thulium fiber laser (TFL), smaller size single use digital flexible ureterosopes and intraoperative intrarenal pressure (IRP) measurement devices. We aimed to clarify the impact of UASs on IRP, complications and SFRs and put its indications in perspective of these three major technological improvements. A systematic review of the literature using the Medline, Scopus and Web of Science databases was performed by two authors and relevant studies were selected according to PRISMA guidelines. Recent studies showed that using a UAS lowers IRP and intrarenal temperature by increasing irrigation outflow during RIRS. Data on the impact of a UAS on SFRs, postoperative pain, risk of infectious complications, risk of ureteral strictures and risk of bladder recurrence of urothelial carcinoma after diagnostic RIRS were inconclusive. Prestenting for at least one week resulted in ureteral enlargement, while the influence of pre-operative administration of alpha-blockers was unclear. Since TFL, smaller single use digital ureteroscopes and devices with integrated pressure-measuring and aspiration technology seemed to increase SFRs and decrease pressure and temperature related complications, indications on the use of a UAS may decrease in the near future.

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Section: Resultssupporting

confidence: 89%

Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review

Coninck

Somani

Şener

et al. 2022

JCM

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“…Overall, a UAS was placed in 603 procedures in the cohort of selected studies ( Table 2 ). Anbarasan et al [20] analyzed a whole group of patients (21) who underwent FURSL with an access sheath; Mosquera et al [26] reported one of the largest UAS cohorts in pediatric patients carried out in two high-volume endourology centers, including 48 cases. Most groups used a 9.5 or 11.5 Fr UAS (three used 9.5 Fr UAS, three 11–9.5 Fr UAS, seven 11.5–9.5 UAS, and one 10–12 Fr UAS).…”

Section: Evidence Synthesismentioning

confidence: 99%

“…Intraoperative complications included: rupture of the laser fiber during lithotripsy, intrarenal bleeding, ureteral injury [13] , pelvicalyceal system or ureteric injury [14] , ureteric damage [19] , ureteral perforation with extravasation, submucosal wire, and proximal stent migration [27] , and one case of distal ureteral stricture requiring ureteral reimplantation [29] . Postoperative complications reported were the following: fever, obstructive pyelonephritis [13] , hematuria [17] , [18] , [32] , sepsis [14] , [16] , vomiting, urinary tract infection [17] , [18] , [21] , [26] , pain, urinary retention [16] , hydrocalyx [18] , ureteral wall injury [17] , postoperative hydronephrosis [27] , voiding symptoms, and rehospitalization [30] . Six studies reported no postoperative complications [15] , [20] , [22] , [23] , [25] , [28] .…”

Section: Evidence Synthesismentioning

confidence: 99%

Role of Pediatric Ureteral Access Sheath and Outcomes Related to Flexible Ureteroscopy and Laser Stone Fragmentation: A Systematic Review of Literature

Ripa¹,

Tokas²,

Griffin³

et al. 2022

European Urology Open Science

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“… 33 Use of UAS is attracting increased attention in the paediatric population. 34 A recent global study revealed that this ancillary device was used routinely in over 50% of cases. 35 However, given the lack of long-term data and potential risks for ureteric injury, it is not part of our routine practice.…”

Section: Discussionmentioning

confidence: 99%

Ureteroscopy for stone disease in the paediatric population: lessons learned and outcomes in a Nordic setting

Juliebø‐Jones

Æsøy

Gjengstø

et al. 2022

Therapeutic Advances in Urology

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Introduction: Paediatric stone disease is rare in the Nordic communities. Still, the condition can require surgical intervention in the form of ureteroscopy (URS). Here, we report outcomes achieved at a regional (tertiary) centre. Patients and methods: Retrospective analysis was performed of consecutive patients (<18 years of age) undergoing URS for stone disease between 2010 and 2021. Outcomes of interest included stone-free rate (SFR) determined using a definition of no residual fragments ⩾ 3 mm on imaging and complications classified according to Clavien–Dindo system. Results: In total, 23 patients underwent 47 URS procedures for a total of 31 stone episodes. Mean age was 9 (range 1–17) years and male-to-female ratio was 6:17. Overall, 35% had at least one medical comorbidity. Ultrasound determined preoperative stone status in 87%. Mean largest index and cumulative stone sizes were 9 (range 3–40) and 12 (range 3–40) mm, respectively. Overall, 32% had multiple stones. Lower pole was the commonest stone location (39%). No patients underwent elective pre-operative stenting. Ureteral access sheaths were not used in any cases. Access to upper urinary tract at first procedure was successful in 94%. Initial and final SFR was 61% and 90%, respectively. No intra-operative complications were recorded. Overall post-operative complication rate was 17.5%. Urinary tract infection (CD II) was the commonest adverse event (12.5%). Conclusion: Paediatric URS can be delivered in the setting of a regional centre without compromising outcomes. This includes when carried out by adult endourologists, without routine pre-stenting and omitting use of ureteric access sheath.

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Safety and Outcomes of using ureteric access sheath (UAS) for treatment of Pediatric renal stones: Outcomes from 2 tertiary endourology centers

Cited by 15 publications

References 16 publications

Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review

Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review

Role of Pediatric Ureteral Access Sheath and Outcomes Related to Flexible Ureteroscopy and Laser Stone Fragmentation: A Systematic Review of Literature

Ureteroscopy for stone disease in the paediatric population: lessons learned and outcomes in a Nordic setting

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