Use of the ureteral access sheath during ureteroscopy: A systematic review and meta-analysis

Huang, Jian; Zhao, Zhijian; Alsmadi, Jad; Liang, Xiongfa; Zhong, Fangling; Zeng, Tao; Wu, Weizhou; Deng, Tuo; Lai, Yongchang; Liu, Luhao; Zeng, Guohua; Wu, Wenqi

doi:10.1371/journal.pone.0193600

Cited by 52 publications

(38 citation statements)

References 29 publications

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“…A previous systemic review and meta-analysis by Huang et al showed no difference in SFR, operative time and intraoperative complications with the use of UAS although the post-operative complications were slightly higher with its use [28]. Our prospective data of consecutive patients with renal stones show similar results in both groups although with a slightly higher operative time in patients with UAS owing to higher stone size, multiplicity and the time taken to insert the sheath itself.…”

Section: Discussionsupporting

confidence: 70%

Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period

et al. 2019

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Purpose To compare the outcomes (stone free rate and complications) of renal stone treatment with and without the use of ureteral access sheath (UAS). The worldwide use of UAS has risen over the last decade; however, questions still remain on the safety and outcomes with its use. We wanted to look at the role of UAS for treatment of consecutive renal stones over a 7-year period. Methods The outcomes of flexible ureteroscopy and stone treatment (FURS) for renal stones with and without the use of UAS was prospectively compared from March 2012 to July 2018. Patients were divided into two groups: group-1 where UAS was used for stone treatment and group-2 where a UAS was not used. Data were collected prospectively on consecutive patients for demographics, stone size, location and number, pre and post-operative stent usage, operative time duration, stone free rate (SFR), length of stay and complications. Results During the study period, 338 patients underwent FURS for renal stones, of which a UAS was used for 203 (60%) patients. The mean age of patients was 56 years (range 2-89 years) with a male:female ratio of 204:134. The mean cumulative stone size and the mean number of stones was 16.5 ± 10.8 mm and 11.37 ± 8.08 mm (P < 0.001), and 2.17 ± 1.99 and 1.66 ± 1.50 (P = 0.009) for groups 1 and 2 respectively. The pre and post-operative stent insertion rates were similar in the two groups. The procedural time was longer in group-1 (54.8 ± 25.8 min) compared to group-2 (41.3 ± 22.2 min) (P < 0.001). The SFR for group-1 (88%) was slightly lower than group-2 (94%) although this was not statistically significant (P = 0.07). There were no intra-operative complications in either of the groups. Post-operative complications were seen in eight patients in group-1 (7 Clavien I/II and 1 Clavien IVa) and two patients in group-2 (Clavien I) (P = 0.19). Conclusion The use of UAS for renal stones is safe with no intra-operative complications noted in our series. Good stone-free rates were obtained for large and multiple renal stones with a small risk of minor complications post-operatively.

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Section: Discussionsupporting

confidence: 70%

Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period

et al. 2019

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“…[19] Despite being controversial and a lack of overwhelming support, UAS is widely used in RIRS. [20] The guidelines of the European Association of Urology have no clear recommendations for UAS usage, whereas the American Urological Association guidelines recommend the use of a UAS when performing RIRS for complex, high-volume renal stones. [21,22] The natural ureteral lumen is 9-F, narrower than any UAS on the market.…”

Section: Discussionmentioning

confidence: 99%

Impact of Ureteral Access Sheath Force of Insertion on Ureteral Trauma: In vivo preliminary study with 7 patients

Tefik¹,

Butticé²,

Somani³

et al. 2018

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Ureteral access sheaths (UASs) are commonly used in retrograde intra-renal surgery (RIRS). Despite their advantages, there is a risk of ureteral trauma during their placement and subsequent stricture following surgery. The aim of this study was to evaluate the UAS force of insertion (FOI) during placement and its impact on ureteral trauma. METHODS: Seven female patients who underwent RIRS for kidney stones were included in the study. A digital force gauge (Chatillon DFX II; Ametek Test and Calibration Instruments, Largo, Florida, USA) was connected to the distal end of the UAS and the UAS FOI was continuously measured during insertion. UASs of different sizes were used and ureteral injury was evaluated under direct vision with the Post-Ureteroscopic Lesion Scale (PULS) score. RESULTS: Five pre-stented patients and 2 non-stented patients were included in the study. The size of the UASs used in non-stented patients was 9.5/11.5-F and 10/12-F, whereas one 11/13-F and four 12/14-F sheaths were used in the pre-stented patients. The highest maximal UAS FOI observed was 5.9 Newton (N) in a pre-stented patient with a 12/14-F UAS, where a second attempt was performed after initial failure. The lowest maximal UAS FOI was 0.91 N in a non-stented patient using a 9.5/11.5-F UAS. A semirigid ureteroscopy with a 7.8-F sheath was performed in this patient prior UAS placement. The PULS score was 1 in the 2 non-stented patients and 0 in all of the pre-stented patients. CONCLUSION: In this small cohort, a preoperative JJ stent seemed to protect the ureter, even with larger diameter UASs of 12/14-F. Non-stented RIRS with a UAS is possible, but may cause low-grade ureteral trauma.

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“… 52 In fact, a systematic review of ureteral access sheaths reports an association with increased risk of postoperative complications. 53 The concern for renal pelvic pressures stems from the notion that persistent pressures in excess of normal range may be attained during ureteroscopy and that this may increase the risk of postoperative infection. Although there are currently no systematic studies supporting these practices, we propose that it is good clinical practice to limit operative time and to endeavor to maintain low irrigation pressures as well as consistent decompression of the upper urinary tract.…”

Section: Preventionmentioning

confidence: 99%

Prevention and management of urosepsis triggered by ureteroscopy

Scotland¹,

Lange²

2018

RRU

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Urosepsis is a potentially life-threatening phenomenon that may occur after an ureteroscopic procedure. With the increasingly widespread adoption of ureteroscopy, there is a concern that the rates of urosepsis may increase. This review examines the current work being undertaken to minimize postprocedure infections both in the field of device development and in clinical care. Guidelines for the diagnosis and management of urosepsis will be discussed.

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Use of the ureteral access sheath during ureteroscopy: A systematic review and meta-analysis

Cited by 52 publications

References 29 publications

Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period

Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period

Impact of Ureteral Access Sheath Force of Insertion on Ureteral Trauma: In vivo preliminary study with 7 patients

Prevention and management of urosepsis triggered by ureteroscopy

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