Ureteral Wall Injury with Ureteral Access Sheaths: A Randomized Prospective Trial

Loftus, Christopher; Ganesan, Vishnu; Traxer, O.; Schold, Jesse D.; Noble, Mark J.; Sivalingam, Sri; Muruve, Nicolas A.; Monga, Manoj

doi:10.1089/end.2018.0603

Cited by 32 publications

(22 citation statements)

References 12 publications

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“…Ureteroscopic lithotripsy (URSL) using a ureteral access sheath is becoming increasingly popular worldwide because of advantages that include reduced intrarenal pressure, multiple entry and reentry, scope protection, and avoidance of bulking. [1][2][3] However, the risk of ureteral injury after ureteral access sheath use should be considered; Loftus et al 4 reported that ureteral access sheath-related ureteral injury may lead to ureteral stricture formation. Although the standard ureteral access sheath has an external diameter of 14 Fr, Zelenko et al 5 reported that the mean diameter of the non-prestented ureter was 3 mm, according to imaging analysis.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of ureteral injuries caused by ureteral access sheath insertion during ureteroscopic lithotripsy

Taguchi

Yasuda

Kinoshita

2022

Preprint

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Objective: To evaluate ureteral injuries caused by insertion of a 13-Fr ureteral access sheath, and to identify factors (other than pre-stenting) that are predictive of ureteral injury. Methods: We enrolled 201 patients who underwent ureteroscopic lithotripsy (URSL). We excluded 80 patients who underwent ureteral stent insertion before URSL, 10 patients who did not use a ureteral access sheath, and two patients in whom a ureteral access sheath could not be inserted. In total, 109 patients were analyzed; all underwent insertion of a 13-Fr ureteral access sheath. We investigated ureteral injuries using the Traxer ureteral injury scale. Results: There were 21 (19.3%) cases of ureteral access sheath-related ureteral injury, including 11 (10.1%) grade 2 cases and 10 (9.2%) grade 3 cases. The ureteral injury location was the proximal ureter in 20 cases (18.3%), middle ureter in one case (0.9%), and distal ureter in 0 cases. Multiple logistic regression analysis showed that male sex was a significant predictive factor for ureteral injury (p = 0.045, odds ratio: 4.87, 95% confidence interval: 1.03–23.01). Postoperative ureteral stricture did not occur in any cases. Conclusion: The rate of ureteral injury caused by a 13-Fr ureteral access sheath was considerable, and most ureteral injuries occurred in the proximal ureter. Male sex was a significant predictive factor for ureteral injury, according to multiple logistic regression analysis. The proximal ureter should be confirmed when using a 13-Fr ureteral access sheath, particularly in male patients.

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Section: Introductionmentioning

confidence: 99%

Evaluation of ureteral injuries caused by ureteral access sheath insertion during ureteroscopic lithotripsy

Taguchi

Yasuda

Kinoshita

2022

Preprint

View full text Add to dashboard Cite

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“…performed ureteroscopy by using two different types of UAS in a randomized trial including 95 patients; Cook Flexor or Boston Scientific Navigator both with a diameter of 12/14 Fr were used. [ 26 ] Ureteroscopy was done for the treatment of urinary stones. Thirty percent of the patients had stones located in the kidney, 63% in the ureter, and 7% of patients had both ureteral and kidney stones.…”

Section: Resultsmentioning

confidence: 99%

Does ureteral access sheath have an impact on ureteral injury?

et al. 2022

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Objective: To present a well-organized review about ureteral access sheath impact on ureteral injury. Materials and Methods: Systemic search on literature was done. Total of 3766 studies observed by two urologists and results were unified. A Prisma diagram was used for eliminating irrelevant studies and at the end of elimination process 28 studies were found eligible for this review. Results: Not only clinical studies but also comparative experimental animal studies show that there is no significant data to claim that ureteral access sheath insertion causes more ureteral injury. Pre-stented patients were found to be at lower risk for ureteral injury. Risk of progression to ureteral injury seems to be low even if ureteral injury occurs with insertion of ureteral access sheath. Conclusion: Summary of studies’ results indicate that use of ureteral access sheath doesn’t increase ureteral injury. This review may help understanding safety profile of ureteral access sheath on evidence-based level. There is not enough data to make a statement that ureteral access sheath prevents ureteral injury.

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“…Loftus et al 4 suggested that surgeons should have a low threshold for switching to a smaller sheath when resistance is encountered or if placement time is prolonged. In our multiple logistic regression analysis, we regarded sex, age, body mass index, impacted stone presence, and preoperative urinary infection as potential predictive factors for ureteral injury.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, they reported that male, older, and non-prestented patients had greater risks of severe ureteral access sheath-related ureteral injuries. In a prospective randomized trial, Loftus et al 4 found the rate of high-grade (grade ≥ 2) injury caused by a 14-Fr ureteral access sheath was 23.9%. Furthermore, they reported that male sex, high stone burden, longer sheath insertion time, and a more difficult subjective rating of sheath placement were associated with high-grade ureteral injuries.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of ureteral injuries caused by ureteral access sheath insertion during ureteroscopic lithotripsy

2023

View full text Add to dashboard Cite

To evaluate ureteral injuries caused by insertion of a 13-Fr ureteral access sheath, and to identify factors (other than pre-stenting) that are predictive of ureteral injury. Methods:We enrolled 201 patients who underwent ureteroscopic lithotripsy (URSL). We excluded 80 patients who underwent ureteral stent insertion before URSL, 10 patients who did not use a ureteral access sheath, and two patients in whom a ureteral access sheath could not be inserted. In total, 109 patients were analyzed; all underwent insertion of a 13-Fr ureteral access sheath. We investigated ureteral injuries using the Traxer ureteral injury scale. Results:There were 21 (19.3%) cases of ureteral access sheath-related ureteral injury, including 11 (10.1%) grade 2 cases and 10 (9.2%) grade 3 cases. The ureteral injury location was the proximal ureter in 20 cases (18.3%), middle ureter in one case (0.9%), and distal ureter in 0 cases. Multiple logistic regression analysis showed that male sex was a signi cant predictive factor for ureteral injury (p = 0.045, odds ratio: 4.87, 95% con dence interval: 1.03-23.01). Postoperative ureteral stricture did not occur in any cases. Conclusion:The rate of ureteral injury caused by a 13-Fr ureteral access sheath was considerable, and most ureteral injuries occurred in the proximal ureter. Male sex was a signi cant predictive factor for ureteral injury, according to multiple logistic regression analysis. The proximal ureter should be con rmed when using a 13-Fr ureteral access sheath, particularly in male patients.

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Ureteral Wall Injury with Ureteral Access Sheaths: A Randomized Prospective Trial

Cited by 32 publications

References 12 publications

Evaluation of ureteral injuries caused by ureteral access sheath insertion during ureteroscopic lithotripsy

Evaluation of ureteral injuries caused by ureteral access sheath insertion during ureteroscopic lithotripsy

Does ureteral access sheath have an impact on ureteral injury?

Evaluation of ureteral injuries caused by ureteral access sheath insertion during ureteroscopic lithotripsy

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