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

Coninck, Vincent De; Somani, Bhaskar K.; Şener, Tarık Emre; Emiliani, Esteban; Corrales, Mariela; Juliebø‐Jones, Patrick; Pietropaolo, Amelia; Mykoniatis, Ioannis; Hameed, B. M. Zeeshan; Esperto, Francesco; Proietti, Silvia; Traxer, Olivier; Keller, Etienne Xavier

doi:10.3390/jcm11175128

Cited by 46 publications

(18 citation statements)

References 62 publications

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“…The potential risks associated with certain devices such as UAS and balloon dilators are widely reported 12–14 . Indeed, these form part of the common arguments against their use.…”

Section: Discussionmentioning

confidence: 99%

Adverse events related to accessory devices used during ureteroscopy: Findings from a 10‐year analysis of the Manufacturer and User Facility Device Experience (MAUDE) database

et al. 2023

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ObjectivesThe objective of this study was to evaluate adverse events and device events related to accessories used during ureteroscopy (URS).Materials and methodsAnalysis was performed of the records available in the Manufacturer and User Facility Device Experience database in the United States. Information was collected on characteristics of problem, timing, manufacturer verdict, successful completion of planned surgery, prolonged anaesthesia and injury to patient or staff.ResultsFive‐hundred seventy‐one events related to URS accessories were recorded. These were associated with the following devices: baskets (n = 347), access sheath (n = 86), guidewires (n = 78), balloon dilators (n = 27), ARDs (n = 17) and ureteral catheters (n = 16). Of the events, 12.7% resulted in patient injuries. Forty‐eight per cent of the events resulted in prolonged anaesthesia, but the planned surgery was successfully completed in 78.4% of all cases. Collectively, the manufacturers accepted responsibility due to actual device failure in only 0.5% of cases. Common problems for baskets were failure to deploy (39.5%) and complete detachment of basket head (34.6%) and partial breakage of the basket head (12.4%). Of the basket group, 4.3% required open or percutaneous surgery to remove stuck basket. Full break of the body of the access sheath occurred in 41.9% and complete ureteral avulsion in 3.5%. For balloon dilators, there was a burst in 37% of cases. Broken guidewires were associated with 11.5% requiring repeat intervention for retrieval and 6.4% required JJ stent due to perforation to the collecting system. No injuries to operating staff were recorded with accessory usage.ConclusionAccessories used during URS are fragile. Potential for serious injury does exist as a direct result of their use. Surgeons should familiarise themselves with these events and how they can be prevented.

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“…The potential risks associated with certain devices such as UAS and balloon dilators are widely reported 12–14 . Indeed, these form part of the common arguments against their use.…”

Section: Discussionmentioning

confidence: 99%

Adverse events related to accessory devices used during ureteroscopy: Findings from a 10‐year analysis of the Manufacturer and User Facility Device Experience (MAUDE) database

et al. 2023

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“…50 These miniaturisations can also potentially serve to reduce need for prestenting. 51 Role of UAS. An increasing number of series examining the role of UAS have been reported, and a recent multicentre study recorded their use is now routine in more than half of the cases performed.…”

Section: Therapeutic Advances In Urologymentioning

confidence: 99%

Paediatric kidney stone surgery: state-of-the-art review

Juliebø‐Jones

Keller

Tzelves

et al. 2023

Therapeutic Advances in Urology

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While urolithiasis in children is rare, the global incidence is rising, and the volume of minimally invasive surgeries being performed reflects this. There have been many developments in the technology, which have supported the advancement of these interventions. However, innovation of this kind has also resulted in wide-ranging practice patterns and debate regarding how they should be best implemented. This is in addition to the extra challenges faced when treating stone disease in children where the patient population often has a higher number of comorbidities and for example, the need to avoid risk such as ionising exposure is higher. The overall result is a number of challenges and controversies surrounding many facets of paediatric stone surgery such as imaging choice, follow-up and different treatment options, for example, medical expulsive therapy, shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy. This article provides an overview of the current status of paediatric stone surgery and discussion on the key topics of debate.

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“…Въпреки, че fURS е безопасна и ефектив-на процедура, все още се търсят начини за повишаване на ефективността ù в някои клинични ситуации. Остава дискутабилен и въпросът за приложението на UAS, въпреки теоретичните му предимства, включващи намаляване на интрареналното налягане, възможност за многократно въвеждане на уретероскопа до горния уринарен тракт и подобрена визуализация от оптимизираната иригация [14,15]. Понастоящем няма препоръки относно приложението на UAS, тъй като данните от литературата са лимитирани и няма голям брой рандомизирани проучвания, потвърждаващи предимствата от приложението му [11,14].…”

Section: материал и методиunclassified

“…Остава дискутабилен и въпросът за приложението на UAS, въпреки теоретичните му предимства, включващи намаляване на интрареналното налягане, възможност за многократно въвеждане на уретероскопа до горния уринарен тракт и подобрена визуализация от оптимизираната иригация [14,15]. Понастоящем няма препоръки относно приложението на UAS, тъй като данните от литературата са лимитирани и няма голям брой рандомизирани проучвания, потвърждаващи предимствата от приложението му [11,14]. Въпреки това, голяма част от ендоуролозите прилагат UAS при извършването на fURS за лечение на конкременти в бъбрека [16].…”

Section: материал и методиunclassified

Impact of ureteral access sheath use on outcomes of flexible ureteroscopy for renal stones

Petkova¹,

Petrov²,

Петрова³

et al. 2022

JEMIS

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Introduction and objective: Improvements in endoscopic technologies have led to an expansion of flexible ureteroscopy indications in the treatment of renal and ureteral stones. Ureteral access sheath (UAS) was introduced in the clinical practice to facilitate endoscopic access into the upper urinary tract, reduce intrarenal pressure during the procedure and allow the extraction of fragments. The objective of this study is to analyze the impact of UAS on the efficacy and safety of flexible ureteroscopy (fURS) for the treatment of renal stones. Material and methods: a prospectively collected database including 251 consecutive patients treated with fURS between January 2018 and November 2022 was analyzed. Patients were divided into two groups: group 1 – without UAS, 21 patients (8.3%) and group 2 – with UAS, 231 patients (91.7%). UAS was used at the surgeon’s discretion and 3 patients (1.2%) underwent a sheathless procedure due to failure of UAS insertion. Data on patients’ preoperative characteristics and fURS efficacy and safety were compared. Results: There were no statistically significant differences in patients’ preoperative characteristics except for stone size and surface, which were significantly larger in group 2 (9.6±4.1 vs 13.8±5.2 mm; р<0.001 and 68.6±74.2 vs 128.3±109.3 mm2, p=0.002, respectively). Operating time was significantly longer in group 2 (33.6±12.9 vs 42.0±12.9 min, p=0.005). Stone-free rate after a single procedure and at 3rd postoperative month was similar between groups (95.2% vs 87%, p=0.486 and 95.2% vs 88.7%, p=0.709, respectively). The intra- and postoperative complication rates were higher for group 1 (4.8% vs 0.8%, р=0.011 and 14.3% vs 12.1%, p=0.062, respectively). Multivariate regression model identified stone surface (р<0.001), number of stones (p=0.005) and calcium oxalate monohydrate stone composition (р=0.005), but not UAS use (p=0.580), as independent predictors for stone-free rate following fURS. Conclusions: The results of this study suggest that UAS use has no impact on the efficacy of fURS and is not associated with an increased rate of intra- and postoperative complications.

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

Cited by 46 publications

References 62 publications

Adverse events related to accessory devices used during ureteroscopy: Findings from a 10‐year analysis of the Manufacturer and User Facility Device Experience (MAUDE) database

Adverse events related to accessory devices used during ureteroscopy: Findings from a 10‐year analysis of the Manufacturer and User Facility Device Experience (MAUDE) database

Paediatric kidney stone surgery: state-of-the-art review

Impact of ureteral access sheath use on outcomes of flexible ureteroscopy for renal stones

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