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

Breda, Alberto; Emiliani, Esteban; Millán, Félix; Scoffone, Cesare Marco; Knoll, Thomas; Osther, Palle Jørn Sloth; Liatsikos, Evangelos

doi:10.1007/s00345-015-1638-9

Cited by 22 publications

(15 citation statements)

References 12 publications

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“…A key innovation was the introduction of a UAS with a slit and a notch in the exposed part of the dilator, allowing the transformation of a coaxially backloaded working guidewire into an extraluminal diverted safety guidewire in a one‐step release mechanism . The advantages are potential reductions in material costs and operating time, as only one guidewire is needed, whereas two guidewires are required for conventional UAS insertion .…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, the vacant dilator lumen at the connection hub offers the possibility of contrast medium opacification during UAS insertion. Two shortcomings are the increased risk of dilator bending at the notch when high insertion forces are applied and the risk of inadvertent dislocation of the working guidewire during UAS insertion . Those shortcomings may potentially lead to UAS insertion failure and ureteral damage.…”

Section: Resultsmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Systematic review of ureteral access sheaths: facts and myths

et al. 2018

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“…Recent studies demonstrated that the Flexor sheath is an effective and safe tool, which requires more force during placement but results in less shearing compared to other single wire systems [8, 9]. Per retail pricing, the Flexor Parallel sheath—although relatively expensive—can result in an overall 27% reduction of disposables costs, as compared to our “Classic” access sheath instrumentation (Table 1).…”

Section: Discussionmentioning

confidence: 98%

The Single Wire Ureteral Access Sheath, Both Safe and Economical

Delto

Wayne

Sidhu

et al. 2016

Advances in Urology

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Introduction. Novel disposable products for ureteroscopy are often inherently more expensive than conventional ones. For example, the Cook Flexor© Parallel™ (Flexor) access sheath is designed for ease and efficiency of gaining upper tract access with a solitary wire. We analyze the cost combinations, efficiency, and safety of disposable products utilized for upper tract access, including the Flexor and standard ureteral access sheath. Methods. We performed a retrospective review from January 2014 to October 2014 of patients undergoing URS for nephrolithiasis, who were prestented for various reasons (e.g., infection). Common combinations most utilized at our institution include “Classic,” “Flexor,” and “Standard.” Total costs per technique were calculated. Patient characteristics, operative parameters, and outcomes were compared among the groups. Results. The most commonly used technique involved a standard ureteral sheath and was the most expensive ($294). The second most utilized and least expensive combination involved the Flexor, saving up to $80 per case (27%). All access sheaths were placed successfully and without complications. There were no significant differences in operative time, blood loss, or complications. Conclusions. In prestented patients within this study, the Flexor combination was the most economical. Although the savings appear modest, long-term impact on costs can be substantial.

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“…In a similar way, Flexor Parallel Rapid Release UAS (Cook, Blooming, USA) has a single wire that can be used as either a working or a safety guidewire. In a study by Breda et al [27] , its overall successful placement rate was found to be 94%, while the rates were 98.5% and 82% in patients with or without a preoperative stent respectively. Preoperative stenting was found to be the only single independent risk factor.…”

Section: Ureteroscopementioning

confidence: 97%

Retrograde intrarenal surgery for renal stones - Part 1

Cleynenbreugel

Kılıç

Akand

2017

Turkish Journal of Urology

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The main aim in the treatment of renal stones is to clearance of the stones completely with the least morbidity. Parallel to the improvements in technology during recent years, new flexible ureterorenoscopes and effective lithotripters such as holmium laser have been developed, thus retrograde intrarenal surgery (RIRS) has become an efficient and safe option in the management of urinary system stone disease with a gradually increasing popularity. Therewithal, innovations in auxiliary equipment such as guide-wires, ureteral access sheath and stone baskets have made this procedure more effective. With this modality, nowadays, the vast majority of renal stones can be treated successfully without need of open surgery or percutaneous nephrolithotomy. RIRS can be used as a primary treatment in patients with renal stones smaller than 2 cm, in cases with prior unsuccessful shock wave lithotripsy (SWL), infundibular stenosis, renoureteral malformation, musculoskeletal deformity, bleeding diathesis as well as obese patients. The efficiency of this procedure has been also proved in pediatric patients. In the first part of this detailed review for RIRS, history, indications and contraindications, preoperative preparation, antibiotic prophylaxis, anesthesia, surgical technique related to flexible ureteroscopes and auxiliary equipment being used, postoperative care and complications of this operation are discussed with up-to-date literature.

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

Abstract: The use of the Flexor©Parallel™ Rapid Release™ (Cook(®), Bloomington, IN, USA) with usage of a single guidewire in a prospective multicentric scenario was clinically applicable in the majority of cases. Pre-stenting increased the chance of a successful insertion from 82 to 98.5 %.

Cited by 22 publications

References 12 publications

Systematic review of ureteral access sheaths: facts and myths

Systematic review of ureteral access sheaths: facts and myths

The Single Wire Ureteral Access Sheath, Both Safe and Economical

Retrograde intrarenal surgery for renal stones - Part 1

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