Ureteral Access Sheath Use and Stenting in Ureteroscopy: Effect on Unplanned Emergency Room Visits and Cost

Rapoport, Daniel; Perks, Alexandra E.; Teichman, Joel M.H.

doi:10.1089/end.2006.0236

Cited by 73 publications

(31 citation statements)

References 19 publications

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“…In a study where effectiveness of these access sheaths was evaluated, its routine intraoperative use during RIRC was recommended in that it decreases costs, and duration of operations, and causes minimal morbidity. [24] In a study by Kourambas et al [25] performed on 59 cases where effectiveness of access sheaths was evaluated, the authors recommended routine use of access sheaths with its advantages of decreased morbidity, and expenditures. The most important disadvantage of access sheaths is their potential to cause ureteral injury because of their dimensions.…”

Section: Discussionmentioning

confidence: 99%

Flexible ureterorenoscopy results: Analysis of 279 cases

Elbir

Basibuyuk

Topaktaş

et al. 2015

Turkish Journal of Urology

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Objective: In this study, the outcomes of 279 cases in whom we performed retrograde intrarenal surgery (RIRS) were evaluated retrospectively. Material and methods:RIRS was performed on 279 cases with the aid of access sheath of guidewire between March 2011 and February 2015. All patients were operated in the standard lithotomy position. A hydrophilic guidewire was inserted with the aid of rigid ureterorenoscopy and we checked whether there were any residual ureteral stones and other pathologies. Fluoroscopy was used routinely in all cases. Stone fragments smaller than 3 mm were left off but those bigger than 3 mm were removed by grasper after stone fragmentation. Controls of the patients were assessed by plain films (KUB), urinary tract ultrasonography (US) and/or computed tomography (CT) 1 month after the operation. Success rate of the procedure was defined as the stone-free status or presence of residual fragments less than 3 mm.Results: 152 of the patients were male and 127 were female. The median ages of the male and female patients were 47.7 (1-86) ve 45.9 (3-79) years respectively. The median stone size was 13.5 mm (8-25). Preoperatively 34 (12.1%) patients had double-J ureteral stent. 19 (6.8%) patients were operated while they were still receiving antithrombotic and antiplatelet therapy Solitary kidney was present in 24 patients while the remaining patients had kyphoscoliosis (n=3), rotation anomaly (n=6), pelvic kidney (n=2), double collecting system (n=3), and horseshoe kidney (n=6). In 264 patients access sheath was used, in 15 patients operation was performed with the help of the guidewire. Double-J stents were inserted to 14 patients because of ureteral stricture and they underwent operation after 2 weeks later. Renal stones of 219 patients among all cases were fragmented completely and the patients were discharged as stone free (SF). Our success rate (SF or presence of clinically insignificant residual [CIRF]) was 78.4%. Stone size (p= 0.029), stone number (p= 0.01), stone location (p= 0.023) had significant influence on the stone-free rate after RIRS The mean operation and floroscopy time was 62.5 min. (40-180) and 29.8 sec (4-96), respectively. The mean hospitalization time was 26.4 hours (12-72). Double J stents were placed to 253 patients for more stone burden and ureteral edema. Any complication was not observed for all cases except perioperative developed infection for two patients. Conclusion:With advances in laser technology and flexible ureterorenoscopy, kidney stones can be treated with lower morbidity and high success rates.

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Section: Discussionmentioning

confidence: 99%

Flexible ureterorenoscopy results: Analysis of 279 cases

Elbir

Basibuyuk

Topaktaş

et al. 2015

Turkish Journal of Urology

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“…Their stenting rate was 39% and limited to impacted stones, severe preoperative obstruction and residual poor postoperative drainage (21). Stents were, additionally, found useful in pregnant ladies (22), in upper urinary tract diseases (urolithiasis) (23) and when ureteral access sheath was used (24). Factors that contribute to DJ--associated morbidity include stent design, size, positioning, associated UTI, and duration (25).…”

Section: Discussionmentioning

confidence: 99%

Emergency double-J stent insertion following uncomplicated Ureteroscopy: risk-factor analysis and recommendations

et al. 2013

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Purpose: Emergency double-J (DJ) stenting following "uncomplicated" ureteroscopic (UURS) stone treatment is both morbid and costly. Our study aims at identifying those patients who are more likely to require such an extra procedure. Handling of this complication will also be highlighted. Materials and Methods: 319 cases of UURS cases were selected out of 903 patients, who were admitted for URS stone treatment at King Abdullah University Hospital during the period from May, 2003 to December, 2010. Thirty-eight of them (11.9%) had emergency post-URS DJ stenting within 24 hours of discharge. The medical records of all UURS cases were retrospectively reviewed. Comparison in demographic and stone-related variables was made using 2-paired t-test with P < 0.05. Operative findings of 38 stented patients were outlined. Results: Significant risk factors for emergency stenting were noted in males with larger (> 1.5 cm) and proximal stones (38 stented vs. 281 unstented). Operative risk factors among the 38 patients were: initial procedure time > 45 minutes (42.1%), ureteral wall edema (21.1%), repeated access for stones > 1.5 cm (21.1%), impacted stone (10.5%) and ignored or missed stones/fragments (4.6%). Conclusions: The need for emergency DJ stenting following UURS stone treatment is not uncommon. The routine insertion is impractical and weakly-supported. With risk-factor stratification, selective and individualized DJ stenting policy is recommended.

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“…95 This was also corroborated by Canadian data where patients who did not have a ureteral stent were more likely to have an emergency room visit in the postoperative period (37% vs. 14%, p = 0.04). 96 …”

Section: Stenting Following Use Of a Uasmentioning

confidence: 99%

CUA Guideline: Management of ureteral calculi

Ordon

Andonian²,

Blew³

et al. 2015

CUAJ

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The focus of this guideline is the management of ureteral stones. Specifically, the topics covered include: conservative management, medical expulsive therapy, active intervention with either shockwave lithotripsy (SWL) or ureteroscopy (URS), factors affecting SWL treatment success, optimizing success, and special considerations (e.g., pregnancy, urinary diversion). By performing extensive literature reviews for each topic evaluated, we have generated an evidence-based consensus on the management of ureteral stones. The objective of this guideline is to help standardize the treatment of ureteral stones to optimize treatment outcomes.

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Ureteral Access Sheath Use and Stenting in Ureteroscopy: Effect on Unplanned Emergency Room Visits and Cost

Cited by 73 publications

References 19 publications

Flexible ureterorenoscopy results: Analysis of 279 cases

Flexible ureterorenoscopy results: Analysis of 279 cases

Emergency double-J stent insertion following uncomplicated Ureteroscopy: risk-factor analysis and recommendations

CUA Guideline: Management of ureteral calculi

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