The Impact of Ureteral Access Sheath Size on Perioperative Parameters and Postoperative Ureteral Stricture in Retrograde Intrarenal Surgery

Aykanat, Can; Balcı, Melih; Senel, Cagdas; Ozercan, Ali Yasin; Coser, Seref; Aslan, Yılmaz; Güzel, Özer; Asfuroglu, Ahmet; Karabulut, Erdem; Tuncel, Altuğ

doi:10.1089/end.2021.0751

Cited by 18 publications

(13 citation statements)

References 17 publications

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“…When adjusting for age and gender, the incidence of ureteral lesions was comparable between both groups [ 33 ]. These results contrast with the findings of Aykanat et al who found less ureteral lesions with a smaller UAS (9.5/11.5 Fr vs. 12/14 Fr) in non-prestented patients in a well-conducted prospective study [ 34 ]. In case a 12/14 Fr UAS was used in patients without prestenting, Fully et al recommended to measure the ureteral diameter preoperatively on a noncontrast CT with soft tissue window to predict the risk of ureteral injury by a UAS.…”

Section: Resultscontrasting

confidence: 97%

“…Similarly, Aykanat et al prospectively compared the risk of stricture formation one year after using a 9.5/11.5 Fr and 12/14 Fr UAS in non-prestented patients. 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: Resultsmentioning

confidence: 99%

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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: Resultscontrasting

confidence: 97%

Section: Resultsmentioning

confidence: 99%

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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“…Larger diameter UASs (>12/14 Fr) allow for greater surgical efficacy and intrarenal pressure reduction to safe physiological levels at the cost of increased insertion forces, greater risk of ureteral wall injury, and lower insertion success rates. e use of a 12F/14F UAS in patients who are not previously stented increases the risk of high-grade ureteral injuries; however, despite this increase, there is no difference in ureteral stricture formation [12]. To our best knowledge, these factors were first reported to be associated with the insertion of a 12/14-Fr UAS.…”

Section: Discussionmentioning

confidence: 91%

Identification of the Risk Factors for the Failure of Ureteral Access Sheath Placement

Liu

et al. 2022

International Journal of Clinical Practice

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Purpose. Insertion of a ureteral access sheath (UAS) may fail in some patients in retrograde intrarenal surgery (RIRS), and this study aimed to seek preoperative risk factors for the failure of 12/14F UAS placement. Methods. We retrospectively analyzed 260 consecutive patients who underwent RIRS between May 2020 and March 2022 at our institution. Data on patient and stone characteristics and several computed tomography (CT)-based measurements were collected and compared between the success and failure UAS placement groups. Results. Twenty-nine (11.2%) patients failed to insert the UAS. Age, gender, height, weight, stone side, stone location, length of history, and computed tomography (CT)-based parameters were not significant differences between the two groups. Univariate logistic regression analyses showed sex (female/male) (odds ratio: 0.287 and 95% CI [0.107, 0.722], p = 0.013 ), length of history 15–31 days (odds ratio: 0.315 and 95% CI [0.102, 0.974], p = 0.045 ), length of history >31 days (odds ratio: 0.202 and 95% CI [0.051, 0.805], p = 0.023 ), and diameter of the ipsilateral common iliac artery (odds ratio: 1.285 and 95% CI [1.018, 1.623], p = 0.035 ) were associated with UAS placement. Conclusion. Our study indicated that males, the short length of history, and the short diameter of the ipsilateral common iliac artery were the risk factors for the failure of UAS placement.

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“…Recent studies have shown, however, that the use of 12/14-Fr UAS does not increase the risk of ureteral stricture formation, although it may increase the risk of high-grade ureteral injuries. 23,24 Nevertheless, accidental ureteral injuries should be avoided as much as possible, so a first-look semirigid ureteroscopy before placement of UAS is recommended. 25 In this step, surgeons can check the diameter and the compliance of ureters and assess the appropriate UAS size for each patient.…”

Section: Selection Of Ureteroscope: Semi-rigid Ureteroscope or Flexib...mentioning

confidence: 99%

“…There are concerns that the use of UAS with large diameter may lead to postoperative ureteral stricture due to iatrogenic ureteral injury or ureteral ischemia. Recent studies have shown, however, that the use of 12/14‐Fr UAS does not increase the risk of ureteral stricture formation, although it may increase the risk of high‐grade ureteral injuries 23,24 . Nevertheless, accidental ureteral injuries should be avoided as much as possible, so a first‐look semirigid ureteroscopy before placement of UAS is recommended 25 .…”

Section: Retrograde Urslmentioning

confidence: 99%

Comprehensive endoscopic management of impacted ureteral stones: Literature review and expert opinions

et al. 2022

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Treatment of urolithiasis, a benign disease, requires high efficacy and safety. Endoscopic treatment of impacted ureteral stones remains a challenging procedure for urologists, despite recent remarkable advances in surgical technology in treatment of urolithiasis. The success rate of endoscopic treatment in patients with impacted stones is reported to be lower than that in patients with nonimpacted stones. Moreover, the presence of stone impaction is associated with high rates of intraoperative and postoperative complications. The best management for patients with impacted ureteral stones should therefore be devised based on the latest knowledge and techniques. The present review focuses on the preoperative prediction of stone impaction, the safest and most effective endoscopic surgical procedures, and the most appropriate management for postoperative ureteral strictures. We overview comprehensive endoscopic management for impacted ureteral stones based on literature review and expert opinions.

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The Impact of Ureteral Access Sheath Size on Perioperative Parameters and Postoperative Ureteral Stricture in Retrograde Intrarenal Surgery

Cited by 18 publications

References 17 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

Identification of the Risk Factors for the Failure of Ureteral Access Sheath Placement

Comprehensive endoscopic management of impacted ureteral stones: Literature review and expert opinions

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