The Difficult Ureter: Clinical and Radiographic Characteristics Associated With Upper Urinary Tract Access at the Time of Ureteroscopic Stone Treatment

Viers, Boyd R.; Viers, Lyndsay D.; Hull, Nathan C.; Hanson, Theodore J.; Mehta, Ramila A.; Bergstralh, Eric J.; Vrtiska, Terri J.; Krambeck, Amy E.

doi:10.1016/j.urology.2015.08.007

Cited by 28 publications

(24 citation statements)

References 21 publications

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“…A prior study suggested prior ipsilateral ureteral stent or stone surgery increased access rates. 7 The present study found no relationship between prior ureteroscopic intervention, SWL, PCNL, or spontaneous stone passage on future access failure. Our data reveal that proximal ureteral stones are less likely to be accessed for treatment primarily than those in the kidney, mid ureter, or distal ureter.…”

Section: Discussioncontrasting

confidence: 61%

“…There are several relatively small series studies reporting failure rate of primary URS. 6,7 To our knowledge, this is the largest contemporary series that reports this information with modern technology. It is the only multi-center study that we are aware of where failure rate of primary URS is reported as the primary outcome and where predictive factors are determined, with a goal of enhancing patient counseling and the informed consent process.…”

Section: Discussionmentioning

confidence: 97%

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Defining the Rate of Primary Ureteroscopic Failure in Unstented Patients: A Multi-Institutional Study

Fuller

Rycyna

Ayyash

et al. 2016

Journal of Endourology

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A low overall rate of ureteral access failure in unstented patients is shown. Young female patients and proximal ureteral stones were less likely to be accessed primarily. This study provides information that will help urologists counsel their patients preoperatively regarding their likelihood of failing primary URS necessitating a second procedure. This will also help the patient to make an informed decision during the consent process and may guide urologists on selective prestenting in higher risk patients.

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Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 97%

Defining the Rate of Primary Ureteroscopic Failure in Unstented Patients: A Multi-Institutional Study

Fuller

Rycyna

Ayyash

et al. 2016

Journal of Endourology

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“…Both the present study and Traxer et al study [4] contradict other studies which support pre-stenting prior to ureteroscopy and UAS insertion in order to decrease the likelihood of ureteral injury [12] and UAS insertion failure rates [19–21].…”

Section: Discussioncontrasting

confidence: 72%

Practice patterns of ureteral access sheath during ureteroscopy for nephrolithiasis: a survey among endourologists worldwide

et al. 2019

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Background The use of ureteral access sheath (UAS) during ureteroscopy is controversial. We aimed to explore practice patterns of UAS during ureteroscopy for nephrolithiasis among endourologists worldwide. Methods A 15-question survey was designed using the SurveyMonkey® platform. The questions covered the background and professional experience of the potential respondents, indications for UAS insertion, UAS caliber and possible complications associated with its use. The questions were anonymously tabulated in order to determine practice patterns of UAS during ureteroscopy for nephrolithiasis among endourologists. The survey was then distributed via e-mail to all the Endourological Society members. Results 216 members responded. 99.53% of the respondents practice as endourologists, 63.4% are fellowship trained and 74.4% are at least 6 years post-fellow. 73.2% practice in an academic facility. 77.3% perform at least 100 ureteroscopies annually. 46 and 76% routinely use UAS for the treatment of ureteral and kidney stones, respectively. In both cases, the 12/14 access sheath is the most common. 42% use UAS in primary ureteroscopy. 90.3% believe that a double J stent insertion is not mandatory prior to UAS insertion. 79.1% think the use of UAS does not increase postoperative complications rate, and if the latter does encounter, then most likely it is either a ureteral stricture (93.2%) or pain (48%). Conclusions UAS is commonly used by highly skilled endourologists during ureteroscopy. 12/14 UAS is mostly used. Ureteral stricture and post-operative pain are proposed as possible complications following UAS introduction, however pre-stenting is not mandatory as overall low complication rate is expected.

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“…Indeed, pre‐stenting has been shown to be a predictor of successful UAS insertion, along with older age, former endoscopic ureteral surgery and smaller stone burden . The UAS insertion failure rate in non‐pre‐stented cases ranges from 16% to 42%, vs 0% to 12% in pre‐stented cases . In addition, pre‐stenting has been shown to reduce ureteral injuries .…”

Section: Resultsmentioning

confidence: 99%

“…The main shortcomings of pre‐stenting are the necessity for at least two separate operating sessions as well as JJ stent‐related morbidity; therefore, some authors advise active ureteral dilatation using a semi‐rigid ureteroscope, a balloon dilator or serial coaxial tapered dilators, with increasing size in cases of primary UAS insertion failure . Alternatively, some authors insert the inner UAS dilator prior to the insertion of the whole UAS unit . To date, only descriptive studies on active ureteral dilatation are available and nobody has compared the risk of long‐term ureteral damages between active and passive dilatation .…”

Section: Resultsmentioning

confidence: 99%

Systematic review of ureteral access sheaths: facts and myths

et al. 2018

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The aim of the present paper was to review the literature on all available ureteral access sheaths (UASs) with their indications, limitations, risks, advantages and disadvantages in current modern endourological practice. Two authors searched Medline, Scopus, Embase and Web of Science databases to identify studies on UASs published in English. No time period restriction was applied. All original articles reporting outcomes or innovations were included. Additional articles identified through references lists were also included. Case reports, editorials, letters, review articles and meeting abstracts were excluded. A total of 754 abstracts were screened, 176 original articles were assessed for eligibility and 83 articles were included in the review. Based on a low level of evidence, UASs increase irrigation flow during flexible ureteroscopy and decrease intrapelvic pressure and probably infectious complications. Data were controversial and sparse on the impact of UASs on multiple reinsertions and withdrawals of a ureteroscope, stone-free rates, ureteroscope protection or damage, postoperative pain, risk of ureteral strictures, and also on its cost-effectiveness. Studies on the benefit of UASs in paediatrics and in patients with a coagulopathy were inconclusive. In the absence of good randomized data, the true impact of UASs on surgery outcome remains unclear. The present review may contribute to the evidence-based decision-making process at the individual patient level regarding whether or not a UAS should be used.

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The Difficult Ureter: Clinical and Radiographic Characteristics Associated With Upper Urinary Tract Access at the Time of Ureteroscopic Stone Treatment

Cited by 28 publications

References 21 publications

Defining the Rate of Primary Ureteroscopic Failure in Unstented Patients: A Multi-Institutional Study

Defining the Rate of Primary Ureteroscopic Failure in Unstented Patients: A Multi-Institutional Study

Practice patterns of ureteral access sheath during ureteroscopy for nephrolithiasis: a survey among endourologists worldwide

Systematic review of ureteral access sheaths: facts and myths

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